Screening for MASLD is Cost-Effective for Patients, Study Suggests

Screening for the presence of high-risk metabolic dysfunction-associated steatotic liver disease (MASLD) is cost-effective, new findings suggest, and consideration of these screening strategies use within primary care is recommended.¹

These data resulted from new research conducted given the rising global prevalence of MASLD and the clinical and economic burdens associated with the condition also remain an issue. This research was led by Zobair M. Younossi, MD, MPH, of the Beatty Liver and Obesity Research Program of Inova Health System in Falls Church, Virginia.

Although there have been advances in new non-invasive test (NIT) algorithm development and an approval of resmetirom in the US, the investigators noted that very little research has evaluated the cost-effectiveness of screening strategies among those who have MASLD.²

“Therefore, the aim of this study was to evaluate the cost-effectiveness of various strategies to identify high-risk MASLD patients that is initiated in the primary care setting, as recommended by the recent guidelines,” Younossi and colleagues wrote. “By employing a cost-utility model, we assess the incremental cost-effectiveness ratio (ICER) of these strategies, offering important insights into the most efficient methods for managing this increasing disease.”¹

Trial Design

The investigators created a cost-utility model for the purposes of evaluating the incremental cost-effectiveness ratio (ICER) of 6 different strategies for screening patients suspected of having MASLD within primary care settings. Their model integrates a decision tree as well as a Markov model in the analysis.

Those in the high-risk groups, such as patients with type 2 diabetes (T2D) or obesity and medical complications, were placed into the research team’s decision tree using each screening approach. Through the decision tree, the team evaluated subjects using a sequence of non-invasive tests (NIT).

They began with the Fibrosis-4 (FIB-4) test, followed later by either vibration-controlled transient elastography (VCTE) or an enhanced liver fibrosis (ELF) test. These tests involved the categorization of patients as true positives, true negatives, false positives, or false negatives. Diagnostic accuracy data was drawn by the investigators from meta-analyses and ELF data from the Atellica IM.

The investigators’ model determined the average costs linked to screening, staging, and resmetirom treatment for each screening strategy, and this was based on the aforementioned classifications. Following their decision tree analysis, the research team used a series of Markov models to predict disease progression over the course of a 20-year timeframe.

The team’s models were designed to determine long-term staging and retesting expenses, medical costs, and costs of treatment. They also factored in utilities as well as the distribution of health states over time.

Major Findings

Overall, the screening strategies for high-risk MASLD within the US resulted in additional costs compared to zero screenings. These costs were reported to range between $13,587 - $14,730 per subject with T2D. They ranged from $14,274 - $15,661 per subject with obesity.

Notably however, the investigators determined that a screening diminished one’s long-term costs to between $22,150 - $22,279 for those with T2D, and between $13,704 - $13,705 for those with obesity. This was compared to $24,221 and $14,956, respectively, for those without screenings.

The ICERs for subjects with T2D were shown to range from $26,913 - $27,884 per quality-adjusted life year (QALY). However, for those with obesity, ICERs ranged from $23,265 - $24,992 per QALY. Despite the fact that ICERs were impacted by VCTE availability, they continued to be cost-effective when ELF was implemented as a second-line testing method.

The research team concluded that their findings had been robust across several different key parameters.

“These data have important implications for all stakeholders in the United States including patients, providers, policymakers, and the bio-pharmaceutical industry,” they wrote. “We recommend that all individuals who are at risk for high-risk MASLD seen at primary care setting be risk stratified with NITs according to published guideline.”¹

References

1. ^{Younossi Z, Paik J, Henry L, Stepanova M, and Nader F (2024). Pharmaco-Economic Assessment of Screening Strategies for High-Risk MASLD in Primary Care. Liver Int. https://doi.org/10.1111/liv.16119.}
2. ^{E. B. Tapper, M. M. Hunink, N. H. Afdhal, M. Lai, and N. Sengupta, “Cost-Effectiveness Analysis: Risk Stratification of Nonalcoholic Fatty Liver Disease (NAFLD) by the Primary Care Physician Using the NAFLD Fibrosis Score,” PLoS One 11, no. 2 (2016): e0147237.}