Screening for MASLD and Advanced Fibrosis Among Patients With Obesity: A Cost-Effectiveness Analysis
Arpan Mohanty1, Yin Wang2, Charles Stoecker2
1Section of Gastroenterology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA.
Objective:
The study aimed to compare the cost-effectiveness of various strategies for screening for MASLD-related advanced hepatic fibrosis (fibrosis stage > 2) using the fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM) by transient elastography (TE) in persons with obesity.
Methods:
We created a decision-analytic model comparing three screening strategies: no screening, TE, and FIB-4 followed by TE. We used a Markov transition model to track liver state, with prevalence and transition probabilities specific to the population with obesity. If MASLD was detected, patients were treated with resmetirom.
Results:
We found an incremental cost-effectiveness ratio (ICER) of $234,781 (95% CI: $232,581, $235,608) when comparing TE to no screening with a 10-year interval. We note the ICER of $234,673 (95% CI: $234,033, $235,072) when comparing TE to FIB-4+TE. In multivariate simulations, we found no screening was most likely to be cost-effective for willingness-to-pay for QALY below approximately $250,000.
Conclusions:
Our results suggest routine screening for MASLD in obesity clinics is not cost-effective with resmetirom as the available treatment. A prescreening with FIB-4 before TE did not increase economic efficiency.
