We read with a great interest the excellent Cost effectiveness analysis of fibrosis assessment prior to treatment for chronic hepatitis C patients.
The authors must be congratulated for this comprehensive study already including one of the two new approved tri-therapies.
Their modeling could be just improved by using the same cutoff for the definition of significant fibrosis. For biopsy they used the METAVIR stage F2 but for FibroTest they used 0.58 as the cutoff which is stage F3; probably this will not change significantly the results and the conclusions as they already performed several sensitivity analysis.
However the main ICER will be more rational using 0.48 cutoff instead of 0.58.
As already discussed in the supplementary file, it would also be interesting to assess with the 0.48 cutoff what is the ICER of FibroTest only, assuming that biopsy is not a gold standard (with 25% of false negative/positive for 25mm biopsy) using as proposed the extreme scenario with no false positive/negative for FibroTest.
Finally a comment about the relative impact of the applicability of FibroTest (98% applicable) and biopsy (70% greater than 15mm length applicable) on their results would be appropriate.