S2162 Cost-Effectiveness Analysis of Endoscopic Ultrasound-Guided Liver Biopsy Compared to Percutaneous Liver Biopsy in Patients With and Without Cirrhosis

Introduction: Percutaneous liver biopsy (PC-LB) is an established, minimally invasive technique for obtaining liver tissue samples for the diagnosis and risk stratification of liver disease. More recently, endoscopic ultrasound-guided liver biopsy (EUS-LB) has emerged as a comparable alternative to PC-LB, offering similar safety and efficacy profiles with potential advantages, including superior tissue acquisition, reduced recovery time, and less post-procedural pain. Despite these benefits, limited data are available on the cost-effectiveness of EUS-LB relative to PC-LB. Therefore, we aimed to evaluate the cost-effectiveness of EUS-LB compared to PC-LB in patients with and without advanced fibrosis or cirrhosis. Methods: A state-transition Markov cohort model was constructed to evaluate the cost-effectiveness of EUS-LB compared to PC-LB from the U.S. healthcare system’s perspective. The base case was a 55-year-old patient undergoing liver biopsy for any clinical indication without known cirrhosis. Model inputs, including probabilities, costs (US $ 2024), and quality of life (QOL) estimates, were derived from published literature. Health outcomes expressed in quality-adjusted life years (QALYs), model was run over one-year time horizon with a cycle length of one month and a 3% discount rate was utilized. The primary outcome measure was the incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold (WTP) of $100,000/QALY. One-way and probabilistic sensitivity analyses were conducted. Results: At 1 year, EUS-LB demonstrated greater effectiveness than PC-LB (0.86 QALY vs 0.85 QALY), with an additional cost of $658 per patient. EUS-LB was determined to be cost-effective compared to PC-LB, with an ICER of $58,770/QALY and a WTP threshold of $100,000/QALY. One-way sensitivity analysis confirmed the robustness of these findings, while probabilistic sensitivity analysis, using 10,000 iterations, showed EUS-LB to be cost-effective with a 77% probability. Additionally, in scenario analysis, EUS-LB was cost-saving for patients with advanced fibrosis or cirrhosis compared to PC-LB. Conclusion: EUS-LB is a cost-effective alternative to PC-LB for patients requiring liver biopsy and is cost-saving in those with advanced fibrosis or cirrhosis, as it eliminates the need for subsequent endoscopic variceal screening. These findings underscore the potential of EUS-LB as a multi-purpose, cost-effective modality that reduces the need for multiple procedures while improving patient quality of life.