Authors' results and conclusions: There are many non-invasive tests, including blood tests and imaging, available to diagnose fibrosis in liver disease. A meta-analysis of studies that tested the enhanced liver fibrosis (ELF) test against the reference standard, liver biopsy, showed good diagnostic performance for the test; subsequent diagnostic studies have shown mixed performance. There have been few studies directly comparing ELF to the test used most commonly in clinical practice, transient elastography (typically FibroScan). A comprehensive economic analysis in the UK indicated it was more cost effective to treat everyone with hepatitis C, than to use a diagnostic test for fibrosis before deciding on treatment. New, subsidised hepatitis C drugs were made available in Australia from March 2016, and all patients with hepatitis C are eligible for the treatment, regardless of their level of fibrosis; however, clinicians must know if a patient is cirrhotic or non-cirrhotic when prescribing the treatment.

Authors' recommendations: As the use of non-invasive tests, such as FibroScan, for determining liver fibrosis is increasing, there is a concomitant decrease in the number of liver biopsies being performed. Although determining the level of liver fibrosis is no longer a requirement for patients with hepatitis C to commence treatment, there remains a substantial number of patients with indications other than hepatitis C who will still require such non-invasive imaging to determine the level of liver fibrosis. However, the ELF test may be useful in determining liver fibrosis in patients with cirrhosis, and may be of benefit to those patients in rural and remote locations with no or limited access to other non-invasive means of measuring liver fibrosis. HealthPACT does not support public sector investment in, and use of, the ELF test in routine clinical practice as there are other effective, non-invasive techniques currently in clinical use. However, the ELF test may have a role in determining the degree of liver fibrosis in patients living in rural and remote areas with no or limited access to other means of non-invasive testing.

Project Status: Completed

Year Published: 2016

URL for published report: Not Available

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)