1043-P: Screening for Presence of High-Risk Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) In the U.S. Primary Care Is Cost Effective

Introduction & Objective: Scientific associations recommend a sequential combination of non-invasive tests (NITs) to identify high-risk MASLD patients in primary care, but their cost-effectiveness is unknown.

Methods: Cost-utility model including a decision tree and Markov model was developed to compare nine screening strategies with FIB-4 followed by Enhanced Liver Fibrosis (ELF) or Vibration Controlled Transient Elastography (VCTE) to no-screening. The decision tree distributes patients between true and false positive and negative diagnoses based on the sensitivity and specificity of the diagnostic pathways. The Markov model updated disease state and mortality status over 20-years. Per patient costs, health utilities, and incremental cost-effectiveness ratios (ICERs) were calculated per strategy and reported as quality-adjusted life years (QALYs). The model simulated patients seen at primary care (type 2 diabetes (T2D), prediabetes (Pre-D), or nondiabetic ≥1 cardiometabolic risks (≥1-CMR) without other causes of liver disease). Additional scenario analysis was simulated considering the availability of VCTE and ELF in the U.S.

Results: After 20-years, all 9 screening strategies provided lower cumulative mortality (4.1% to 5.8% reduction), reduction in advanced fibrosis (24.7% to 30.9% reduction) and were cost-effective as compared to no screening [ICERs ranging between $22,119 to $28,778 per QALY gained in T2D, $69,289 to $79,260 in Pre-D, and $69,686 to $80,034 in ≥1-CMR (willingness-to-pay threshold of $100,000 per QALY)]. The cost-effectiveness of screening strategies was consistent with scenario and sensitivity analyses.

Conclusions: Recently published guidelines for high-risk MASLD screening are cost-effective and should be considered in primary care.