Economic evaluation of non-invasive test pathways for high-risk metabolic dysfunction-associated steatotic liver disease (MASLD) in the United Kingdom (UK)
Introduction and Objectives: Non-invasive tests (NITs) identifying high-risk MASLD in primary care is suggested but, these strategies cost-effectiveness remain uncertain in the United Kingdom (UK). Materials and Methods: A cost-utility/budget impact model was developed for cost-effectiveness evaluat...
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Elsevier
2025-07-01
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| Series: | Annals of Hepatology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268125000134 |
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| author | Zobair M. Younossi James M. Paik Linda Henry Richard F. Pollock Maria Stepanova Fatema Nader |
| author_facet | Zobair M. Younossi James M. Paik Linda Henry Richard F. Pollock Maria Stepanova Fatema Nader |
| author_sort | Zobair M. Younossi |
| collection | DOAJ |
| description | Introduction and Objectives: Non-invasive tests (NITs) identifying high-risk MASLD in primary care is suggested but, these strategies cost-effectiveness remain uncertain in the United Kingdom (UK). Materials and Methods: A cost-utility/budget impact model was developed for cost-effectiveness evaluation of two screening strategies (1) FIB-4 followed by Enhanced Liver Fibrosis (ELF) (FIB-4/ELF); (2) FIB-4 followed by Transient Elastography (FIB-4/TE) compared to standard of care (SoC). A cohort of primary care MASLD patients with an advanced fibrosis prevalence of 4.20 % was simulated. A decision tree classified patients as true positives, false positives, true negatives, or false negatives based on NIT diagnostic accuracy, followed by a 3-year Markov model to estimate costs and quality-adjusted life years (QALYs). The model included 11 health states: MASLD, fibrosis stages (F0–F3), cirrhosis, decompensated cirrhosis, liver transplant, and death. Costs came from the National Tariff, National Schedule of Costs and Personal Social Services Research Unit. Results: SoC had a false diagnosis rate of 36.26 %, while FIB-4 with ELF or TE reduced false positive rates to 23.20 % and 20.91 %, respectively. Compared to 112,807 unnecessary hepatology referrals under SoC, FIB-4/ELF or FIB-4/TE reduced unnecessary referrals by 38,031 (33.71 %) and 45,767 (40.57 %), respectively. Both strategies demonstrated cost-effectiveness relative to SoC with total cost per patient of GBP 983.37 for FIB-4/TE, GBP 993.15 for FIB-4/ELF compared to SoC, GBP 1,014.15. Conclusions: Sequential NIT screening strategies, combining FIB-4 with ELF or TE, are cost-saving, reduce unnecessary hepatology referrals, and offer an efficient (improve outcomes and reduce healthcare costs) approach for managing high-risk MASLD in UK primary care. |
| format | Article |
| id | doaj-art-fdf1c02d137c4d34a4f3496191466cfe |
| institution | DOAJ |
| issn | 1665-2681 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
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| series | Annals of Hepatology |
| spelling | doaj-art-fdf1c02d137c4d34a4f3496191466cfe2025-08-20T02:55:13ZengElsevierAnnals of Hepatology1665-26812025-07-0130210178910.1016/j.aohep.2025.101789Economic evaluation of non-invasive test pathways for high-risk metabolic dysfunction-associated steatotic liver disease (MASLD) in the United Kingdom (UK)Zobair M. Younossi0James M. Paik1Linda Henry2Richard F. Pollock3Maria Stepanova4Fatema Nader5The Global NASH Council, Washington DC, USA; Beatty Liver and Obesity Research, Inova Health System, Falls Church, VA, USA; Corresponding author.The Global NASH Council, Washington DC, USA; Beatty Liver and Obesity Research, Inova Health System, Falls Church, VA, USAThe Global NASH Council, Washington DC, USA; Beatty Liver and Obesity Research, Inova Health System, Falls Church, VA, USACovalence Research Ltd, Harpenden, UKThe Global NASH Council, Washington DC, USA; Beatty Liver and Obesity Research, Inova Health System, Falls Church, VA, USA; Center for Outcomes Research in Liver Diseases, Washington DC, USAThe Global NASH Council, Washington DC, USA; Beatty Liver and Obesity Research, Inova Health System, Falls Church, VA, USA; Center for Outcomes Research in Liver Diseases, Washington DC, USAIntroduction and Objectives: Non-invasive tests (NITs) identifying high-risk MASLD in primary care is suggested but, these strategies cost-effectiveness remain uncertain in the United Kingdom (UK). Materials and Methods: A cost-utility/budget impact model was developed for cost-effectiveness evaluation of two screening strategies (1) FIB-4 followed by Enhanced Liver Fibrosis (ELF) (FIB-4/ELF); (2) FIB-4 followed by Transient Elastography (FIB-4/TE) compared to standard of care (SoC). A cohort of primary care MASLD patients with an advanced fibrosis prevalence of 4.20 % was simulated. A decision tree classified patients as true positives, false positives, true negatives, or false negatives based on NIT diagnostic accuracy, followed by a 3-year Markov model to estimate costs and quality-adjusted life years (QALYs). The model included 11 health states: MASLD, fibrosis stages (F0–F3), cirrhosis, decompensated cirrhosis, liver transplant, and death. Costs came from the National Tariff, National Schedule of Costs and Personal Social Services Research Unit. Results: SoC had a false diagnosis rate of 36.26 %, while FIB-4 with ELF or TE reduced false positive rates to 23.20 % and 20.91 %, respectively. Compared to 112,807 unnecessary hepatology referrals under SoC, FIB-4/ELF or FIB-4/TE reduced unnecessary referrals by 38,031 (33.71 %) and 45,767 (40.57 %), respectively. Both strategies demonstrated cost-effectiveness relative to SoC with total cost per patient of GBP 983.37 for FIB-4/TE, GBP 993.15 for FIB-4/ELF compared to SoC, GBP 1,014.15. Conclusions: Sequential NIT screening strategies, combining FIB-4 with ELF or TE, are cost-saving, reduce unnecessary hepatology referrals, and offer an efficient (improve outcomes and reduce healthcare costs) approach for managing high-risk MASLD in UK primary care.http://www.sciencedirect.com/science/article/pii/S1665268125000134Clinical utilityQALYsNITsFIB-4Transient elastography |
| spellingShingle | Zobair M. Younossi James M. Paik Linda Henry Richard F. Pollock Maria Stepanova Fatema Nader Economic evaluation of non-invasive test pathways for high-risk metabolic dysfunction-associated steatotic liver disease (MASLD) in the United Kingdom (UK) Annals of Hepatology Clinical utility QALYs NITs FIB-4 Transient elastography |
| title | Economic evaluation of non-invasive test pathways for high-risk metabolic dysfunction-associated steatotic liver disease (MASLD) in the United Kingdom (UK) |
| title_full | Economic evaluation of non-invasive test pathways for high-risk metabolic dysfunction-associated steatotic liver disease (MASLD) in the United Kingdom (UK) |
| title_fullStr | Economic evaluation of non-invasive test pathways for high-risk metabolic dysfunction-associated steatotic liver disease (MASLD) in the United Kingdom (UK) |
| title_full_unstemmed | Economic evaluation of non-invasive test pathways for high-risk metabolic dysfunction-associated steatotic liver disease (MASLD) in the United Kingdom (UK) |
| title_short | Economic evaluation of non-invasive test pathways for high-risk metabolic dysfunction-associated steatotic liver disease (MASLD) in the United Kingdom (UK) |
| title_sort | economic evaluation of non invasive test pathways for high risk metabolic dysfunction associated steatotic liver disease masld in the united kingdom uk |
| topic | Clinical utility QALYs NITs FIB-4 Transient elastography |
| url | http://www.sciencedirect.com/science/article/pii/S1665268125000134 |
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