Cost-effectiveness of advanced hepatic fibrosis screening in individuals with suspected MASLD identified by serologic noninvasive tests

Our study assessed the cost-effectiveness of screening for hepatic fibrosis in cases suspected of metabolic dysfunction-associated steatotic liver disease (MASLD) using serological noninvasive tests like the fatty liver index (FLI) and hepatic steatosis index (HSI). We applied a decision tree and Markov model from a healthcare system perspective to estimate life-years, quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER) for screening versus no screening in the United States. Prevalence of advanced hepatic fibrosis in individuals suspected of having MASLD was significantly higher when defined by FLI (10.6% vs. 1.3%, P < 0.001) and HSI (8.6% vs. 2.2%, P < 0.001), compared to those without MASLD. Screening (base case) for suspected MASLD defined by FLI had an ICER of $78,647 per QALY and by HSI, $84,874 per QALY, both of which were considered cost-effective based on the implicit ICER threshold of $100,000/QALY in the United States. However, screening for other subgroups without evidence of MASLD was not deemed cost-effective. When applying medical costs and fibrosis distribution data from Korea, similar results were observed. Implementing a two-step screening algorithm for advanced hepatic fibrosis in patients with suspected MASLD based on HSI or FLI calculation is cost-effective in primary care settings.