Frontiers in public health · 2026
Reassessing the Baveno based strategy in China: a cost-effectiveness analysis of screening for high-risk varices in cirrhosis.
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Su Shuhao, Luo Jie, Li Chongxiao, Yang Caiyun, Yang Jiaqi, Ding Dawei, Liu Xingchen, Guo Guanya, Han Ying
Аннотация
BACKGROUND & AIMS: The Baveno consensus recommends using liver stiffness measurement (LSM) and platelet count to avoid endoscopy in low-risk patients with compensated advanced chronic liver disease (cACLD). This study aimed to compare the cost-effectiveness of the Baveno-based selective screening vs. universal screening strategy for high-risk varices (HRV) in a Chinese cACLD cohort.
METHODS: A state-transition Markov model was constructed from the Chinese healthcare system perspective, simulating a cohort of 1,000 patients with cACLD over a five-year horizon. Model inputs were derived from Chinese real-world data, meta-analyses, and national fee schedules. Outcomes included costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), bleeding events, and endoscopic volumes. Sensitivity analyses and scenario analyses were performed to assess the uncertainty.
RESULTS: The selective screening strategy yielded additional QALYs gain (3.4780 vs. 3.4452) and higher cost ($581 vs. $512) over 5 years compared with universal screening, resulting in an incremental cost of $2,103.66 per additional QALY gained and sparing 26% of patients from initial endoscopy. This ICER falls below China's per-capita GDP-based willingness-to-pay (WTP) threshold, indicating that the selective screening is cost-effective in the Chinese context. Deterministic analysis supported these findings, and probabilistic sensitivity analysis showed that selective screening was the preferred strategy in the majority of simulations.
CONCLUSION: Within China's healthcare context, the Baveno-based selective screening strategy is a cost-effective option for screening of high-risk varices in patients with cACLD, suggesting that it should be considered for widespread implementation on clinical and economic grounds.
METHODS: A state-transition Markov model was constructed from the Chinese healthcare system perspective, simulating a cohort of 1,000 patients with cACLD over a five-year horizon. Model inputs were derived from Chinese real-world data, meta-analyses, and national fee schedules. Outcomes included costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), bleeding events, and endoscopic volumes. Sensitivity analyses and scenario analyses were performed to assess the uncertainty.
RESULTS: The selective screening strategy yielded additional QALYs gain (3.4780 vs. 3.4452) and higher cost ($581 vs. $512) over 5 years compared with universal screening, resulting in an incremental cost of $2,103.66 per additional QALY gained and sparing 26% of patients from initial endoscopy. This ICER falls below China's per-capita GDP-based willingness-to-pay (WTP) threshold, indicating that the selective screening is cost-effective in the Chinese context. Deterministic analysis supported these findings, and probabilistic sensitivity analysis showed that selective screening was the preferred strategy in the majority of simulations.
CONCLUSION: Within China's healthcare context, the Baveno-based selective screening strategy is a cost-effective option for screening of high-risk varices in patients with cACLD, suggesting that it should be considered for widespread implementation on clinical and economic grounds.