Cost-effectiveness Analysis Of The Effect Of Weight Loss On The Efficacy Of Non-alcoholic Fatty Liver Disease

Objective:At present,non-alcoholic fatty liver disease(NAFLD)has surpassed hepatitis B virus infection as the main cause of chronic liver disease worldwide,and its clinical and economic burden has become huge.This study evaluates the cost-effectiveness of weight loss on the effect of NAFLD from the perspective of health economics,and further provides theoretical support for clinical decision-making of NAFLD treatment.Methods:Based on the latest NAFLD prevention guidelines,a cost-effectiveness analysis theory and method is used to construct a decision analysis Markov model.The parameters are mainly published in the literature at home and abroad or the results of meta analysis.A hypothetical cohort of 10,000 patients was simulated,based on a cohort of patients with NAFLD aged 55 years.The cost was calculated from a societal perspective.The effect was quality-adjusted life years.The comparison between the two groups of clinical intervention and non-intervention programs used incremental cost-effectiveness ratios.The uncertainty of each parameter in the model is clarified by sensitivity analysis,and the cost-effectiveness acceptance curve of the research program is drawn to evaluate the economics of the program.Through the analysis of clinical intervention and non-intervention survival curves,the effectiveness of the intervention was confirmed.Results:From a societal perspective,the cost-effectiveness of the clinical intervention program is compared with the non-intervention program.The cost of the clinical intervention program is increased by 9018.95 yuan and the effect is increased by0.42883 QALYs.For each additional QALY,21031.63 yuan is required,but it is still lower than the per capita GDP(50237.00 yuan),so it has a high cost-effective value.One-dimensional sensitivity analysis indicates that the effectiveness of clinical intervention compliance has the most obvious effect on the cost of the research plan,and the higher the efficiency of clinical intervention compliance,the higher the economic efficiency of clinical intervention;the second is the poor compliance of clinical intervention The higher the effective rate and the poorer the compliance rate of clinical intervention,the higher the economic efficiency of clinical intervention.The probability sensitivity analysis shows that the increased cost of implementing a clinical intervention program fluctuates between-13000.00-32000.00 yuan(the baseline result is 9018.95yuan),and the increased effect fluctuates between 0.39-0.47(the baseline result is0.42883)and the baseline result within the 95% confidence interval of the Monte Carlo simulation results,the baseline results are reliable,but the incremental cost is uncertain,and clinical intervention may increase social costs and may also save social costs;combined with the per capita GDP of the year as the cost-effect threshold,most of the Monte Carlo simulation results are below the threshold line,suggesting that from a social perspective,the conclusion that clinical intervention programs have higher cost effects is more stable.The probability of the cost effect of the clinical intervention program is positively related to the willingness to pay,and the probability of the cost effect of the non-intervention program is negatively related to the willingness to pay;when the willingness to pay is 0 yuan / QALY,the probability of the cost effectiveness of the clinical intervention program is 14.70% That is,under the premise of not paying the cost,the probability of the clinical intervention program is still 14.70% economically effective;when the willingness to pay is the baseline value(21031.63 yuan / QALY),the probability of the clinical intervention program having a cost effect is 50.20%;When the willingness to pay is the per capita GDP of the year(50237.00 yuan / QALY),the probability of the cost-effectiveness of the clinical intervention program can reach92.70%,suggesting that from a social perspective,the clinical intervention program has not only economic value but also good implementation.After analyzing the survival curve,it was found that compared with non-intervention,the percentage of healthy(without NAFLD)after clinical intervention was 19.39%;except for the higher incidence of NAFL,the proportion of other serious outcomes was lower.As a result,the proportion of deaths was significantly reduced(38.34% in the intervention group and 59.31% in the non-intervention group).Conclusion:1.Although additional interventions are needed to implement clinical weight loss interventions,they can block the adverse outcomes of NAFLD and significantly increase the proportion of benign outcomes,thereby achieving significant clinical effects.From a societal perspective,weight loss has a higher social economic value.2.By grasping these “nodes” such as compliance-related efficiency and NASH?CC transition probability during weight loss clinical intervention,the intervention efficacy can be significantly improved,making it more economically significant.3.With the gradual strengthening of the social material foundation,people are paying more attention to health,and their willingness to "pay" for health,coupled with the significant effect of weight loss clinical interventions,will make weight loss interventions more feasible in the NAFLD population.4.Using Markov model and cost-effectiveness analysis method for NAFLD therapy decision analysis can realize the quantitative optimization of clinical treatment plan,which is worth popularizing and applying.