在2型糖尿病患者中,MASH诊断和管理方法的成本效益
Jeffrey V Lazarus1,2,3, Leire Agirre-Garrido2, Luis Antonio Díaz4,5,6
1City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York.
JAMA network open
|November 6, 2025
概括
查之后的强化生活方式干预 (ILI) 是一种经济有效的策略,用于管理全球2型糖尿病 (T2D) 患者的代谢功能障碍相关的脂肪肝炎 (MASH) 和肝纤维化. 在大多数国家,药物治疗也显示出成本效益.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 内分泌学 在内分泌学.
- 卫生经济学 卫生经济学
背景情况:
- 代谢功能障碍相关的脂肪肝炎 (MASH) 是非传染性疾病 (NCD) 中一个显著的,未被认可的负担,特别影响2型糖尿病 (T2D) 患者.
- 需要有效和成本效益的策略来管理MASH和T2D人口中的肝纤维化.
研究的目的:
- 确定用于预防,检测和治疗T2D患者MASH和肝纤维化的人的成本有效的管理策略.
- 为了比较各种查和治疗干预措施在全球不同的医疗保健环境中的成本效益.
主要方法:
- 对12个国家进行了通用的成本效益分析 (GCEA),涵盖了世卫组织所有6个区域.
- 一个队列状态过渡模型模拟了MASH和肝纤维化在T2D患者一生中的进展.
- 14种管理方法,包括查 (FIB-4,ELF,VCTE) 和药理/非药理治疗,在80%的覆盖率下进行了评估.
主要成果:
- 经过ELF或VCTE查后的强化生活方式干预措施 (ILIs) 在所有评估国家都具有成本效益.
- 在大多数国家,与ILI结合的药理疗法 (semaglutide,resmetirom) 具有成本效益,因特定的药物和位置而有差异.
- 在12个国家中,标准护理在8个国家中是最具成本效益的.
结论:
- 随着ILI的查,代表了管理MASH和T2D患者肝纤维化的普遍成本效益的方法.
- 药理干预在许多环境中提供了具有成本效益的选择,支持世卫组织推的NCD干预措施的发展.
- 这些发现为全球MASH和T2D管理的卫生政策决策提供了关键数据.
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