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Pharmaco-Economic Assessment of Screening Strategies for High-Risk MASLD in Primary Care. | LitMetric

AI Article Synopsis

  • Several scientific associations suggest using a combination of non-invasive tests to identify high-risk patients for metabolic dysfunction-associated steatohepatitis (MASLD), but the cost-effectiveness of these methods is not yet known.
  • A cost-utility model was created to evaluate the cost-effectiveness of various screening strategies for high-risk MASLD patients, particularly those with type 2 diabetes or obesity, comparing the use of initial and secondary testing methods.
  • The study found that while all screening strategies involve additional costs, they lead to significant long-term savings and are deemed cost-effective, reinforcing the recommendation to implement these screening methods in primary care settings.

Article Abstract

Background And Aims: Several scientific associations recommend a sequential combination of non-invasive tests (NITs) to identify high-risk MASLD patients but their cost-effectiveness is unknown.

Methods: A cost-utility model was developed to assess the incremental cost-effectiveness ratio (ICER) of recommended screening strategies for patients with clinically suspected MASLD, specifically those with type 2 diabetes (T2D) and obesity with multiple cardiometabolic risk factors which will be initiated in primary care. Six screening strategies were assessed, using either vibration-controlled transient elastography (VCTE) or the enhanced liver fibrosis (ELF) test as a second-line test following an initial Fibrosis-4 (FIB-4) assessment as the first line NIT. The model included treatment effects of resmetirom for metabolic dysfunction-associated steatohepatitis (MASH) patients with F2 or F3 fibrosis.

Results: All screening strategies for high-risk MASLD in US incurred additional costs compared to no screening, ranging from $13 587 to $14 730 per patient with T2D and $14 274 to $15 661 per patient with obesity. However, screening reduced long-term costs, ranging from $22 150 to $22 279 per patient with T2D and $13 704 to $13 705 per patient with obesity, compared to $24 221 and $14 956 for no screening, respectively. ICERs ranged from $26 913 to $27 884 per QALY for T2D patients and $23 265 to $24  992 per QALY for patients with obesity. While ICERs were influenced by VCTE availability, they remained cost-effective when using ELF as the second-line test. Our findings remain robust across a range of key parameters.

Conclusions: Screening for high-risk MASLD is cost-effective according to recent guidelines. Implementing these screening strategies in primary care should be considered.

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Source
http://dx.doi.org/10.1111/liv.16119DOI Listing

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