Value-based outcome indicators in liver cirrhosis: validation in a large multicenter study (VBMH study)

Background and Aims: Liver Cirrhosis (LC) is responsible for high morbidity, mortality and increasing costs. Aim of our study was to identify outcome indicators (OIs) able to measure quality and value of care in compensated (CC) and decompensated (DC) cirrhosis. Methods: A panel of experts identified a list of OIs using a modified Delphi method; seven of these OIs with the highest RAND/UCLA scores were then tested in a prospective multicenter observational study (Value Based Medicine in Hepatology, VBMH). During 18 months, 1751 patients with LC were enrolled (1004 CC, 747 DC). Results: Annual rate of decompensation (OI#1), annual incidence of first variceal bleeding (OI#2) and annual incidence of HCC (OI#3) in CC were 12%, 2% for low- and 3% for high-risk varices, and 4.3% (81% diagnosed in BCLC-A stage) respectively. One-year survival for CPT score A, B, C was 96%, 81% and 59% (OI#4) respectively, and 94%, 56% when stratified for MELD cut-off of 15 (OI#5). Among DC patients, 4% of them had an episode of variceal bleeding (6 weeks survival 90%, 32% recurrence) (OI#6), 3% had spontaneous bacterial peritonitis (6 weeks survival 86%, 13% recurrence) (OI#7). Conclusions: The seven outcome indicators identified in our study performed well when tested in a large cohort of patients and represent a reference tool to implement a value-based approach to liver diseases.