A decision analysis study of the value of a liver biopsy in nonalcoholic steatohepatitis

Objectives: Nonalcoholic fatty liver disease (NAFLD) is an increasingly prevalent clinical syndrome reflecting a mixture of pathological liver histology with the potential to progress to cryptogenic cirrhosis. Liver biopsy (LB) is the only way to determine the severity of disease. However, LB is invasive, has complications and financial costs. The aim of this study is to determine the benefits of early LB for diagnosis and early treatment. Methods: A decision tree model tracked the potential outcomes of NAFLD between an LB-directed approach vs. no initial LB. Each specific biopsy category determined subsequent care actions. The baseline probabilities were determined by literature review and expert opinion. Results: An initial LB strategy was projected to have a lower mortality compared with the no initial LB group and fewer transplant eligible patients after 5 years. If the prevalence of NAFLD is increased, the mortality increases in both the study groups. With improved efficacy of medical and/or surgical intervention, the mortality rate was decreased. Conclusion: This decision tree model provides a context for balancing the risk and benefit of LB in NAFLD. With early biopsy, and early intervention, the relative return of preventing advanced liver disease per LB was high.