Cost Effectiveness of Diagnosis and Screening Methods in Nonalcoholic Fatty Liver Disease: A Systematic Review

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease that is emerging and spreading worldwide. This condition manifests as a hepatic component of the metabolic syndrome, and its occurrence is closely associated with risk factors such as insulin resistance and abdominal obesity. This study aims to review and analyze the cost-effectiveness of diagnostic and screening methods for NAFLD through a systematic review.

Searches were conducted in Web of science, Scopus, Pubmed, Embase, National Health Services Economic Evaluation Database, Cochrane Database of Systematic Reviews; DAHTA-Database. NHS Health Technology assessment (Centre for review and. DISSEMMINATION Library-CRD), Cost Effectiveness Analysis Registry. The search covered articles published between January 1990 and December 2023. Studies that were written in English and Persian and examined the cost-utility and cost-effectiveness of diagnosis and screening methods in NAFLD were included in our review. Data extraction was guided by the Consolidated Health Economic Evaluation Reporting Standards checklist, and the quality of economic evaluations was assessed using the Criteria for Health Economic Quality Evaluation tool. All costs were converted to 2024 U.S. dollars using Purchasing Power Parity.

The search yielded 1649 studies, and 11 studies were eligible for inclusion. The studies were mainly based on a European setting and then Asian and American alike. Most of the studies used different decision analysis models such as decision tree and Markov to evaluate the cost-effectiveness. The lowest and highest numerical values of outcome measures were 0.021 and 14.46 quality-adjusted life years, respectively. Furthermore, the lowest and highest numerical value of the cost of diagnosis and screening methods in NAFLD were $101, and $123,706, respectively.

Policymakers, decision-makers, and healthcare professionals should consider not only the acceptability, accuracy, sensitivity, accessibility, and feasibility of NAFLD screening and diagnostic strategies but also their cost-effectiveness and affordability, taking into account the financial burden of the disease and local and national cost-effectiveness data.