COST-EFFECTIVENESS OF ULTRASOUND-GUIDED LIVER-BIOPSY

The risk of a major complication from ''blind'' percutaneous liver bio psy is reported to be in the range of 0.24% to 3.8%. In a recent rando mized trial, patients whose liver biopsies were performed with ultraso nography had a significant reduction in complications requiring hospit alization compared with patients without ultrasound-guided biopsies (0 .5% vs. 2.2%, P < .05). Despite this, routine use of ultrasonography f or liver biopsies has not been implemented because of controversies wi th respect to cost-effectiveness. The aim of our study was to analyze the relative cost-effectiveness of performing ultrasound-guided liver biopsies using decision analysis. A decision tree was constructed to c ompare a strategy of liver biopsy using ultrasonography with a strateg y without ultrasonography. The major outcomes included were minor comp lications such as pain requiring analgesics and major complications, w hich require hospitalization. Costs included were direct medical costs from the payer's perspective. In our baseline model, the cost from co mplications per patient with and without ultrasonography was $62 and $ 129, respectively. The marginal effectiveness expressed as the number of major complications avoided was 1.2/100 liver biopsies, The increme ntal cost to avoid one major complication was $2,731. The model was mo st sensitive to the frequency of major complications and the additiona l cost of ultrasonography. Our decision analysis model suggests that u ltrasound-guided liver biopsy is cost-effective. Future studies assess ing the efficacy of image-guided liver biopsies should be conducted.