Reassessing the Baveno based strategy in China: a cost-effectiveness analysis of screening for high-risk varices in cirrhosis

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.