Cost of Metabolic Dysfunction-Associated Steatotic Liver Disease Screening Among All People Living With Diabetes in...

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), are highly prevalent among people living with type 2 diabetes, with estimated rates of 65.4% and 31.6%, respectively, globally. This study aimed to estimate the direct healthcare costs of two MASLD and MASH screening strategies among all people living with diabetes in Brazil, Germany, Japan, the Kingdom of Saudi Arabia (KSA), Spain and the United States (US), from 2026 to 2030.

Strategy 1 consisted of a one-time universal screening of all adults living with diabetes. Strategy 2 involved biennial retesting of individuals who initially tested negative. The Fibrosis-4 (FIB-4) index was used as the first line test, followed by the Enhanced Liver Fibrosis (ELF) test or vibration-controlled transient elastography (VCTE) for confirmatory assessment. Implementation costs were estimated based on the country-specific prevalence of diabetes and included positive price variations that were aligned to monetary policy targets.

Over 5 years, the estimated costs of Strategy 1 ranged from R$0.7-1.3 billion for Brazil, €346-617 million for Germany, ¥80-172 billion for Japan, SAR 3.7-6.0 billion for the KSA, €591-949 million for Spain and $2.7-15.2 billion for the US. Strategy 2 resulted in higher costs, ranging from R$1.2-2.0 billion for Brazil, €528-940 million for Germany, ¥121-262 billion for Japan, SAR 5.7-9.2 billion for the KSA, €0.9-1.4 billion for Spain and $4.1-23 billion for the US.

This study provides valuable guidance for policymakers and healthcare managers to integrate liver fibrosis screening strategies for people living with diabetes into national health budgets.