Cost-Utility Analysis of Non-Invasive Tests to Initiate Hepatocellular Carcinoma Surveillance in Metabolic Dysfunction-Associated Steatotic Liver Disease
Issued Date
2025-01-01
Resource Type
ISSN
00029270
eISSN
15720241
Scopus ID
2-s2.0-85217450926
Pubmed ID
39878449
Journal Title
American Journal of Gastroenterology
Rights Holder(s)
SCOPUS
Bibliographic Citation
American Journal of Gastroenterology (2025)
Suggested Citation
Decharatanachart P., Poovorawan K., Tangkijvanich P., Charatcharoenwitthaya P., Peeraphatdit T., Taychakhoonavudh S., Treeprasertsuk S., Chaiteerakij R. Cost-Utility Analysis of Non-Invasive Tests to Initiate Hepatocellular Carcinoma Surveillance in Metabolic Dysfunction-Associated Steatotic Liver Disease. American Journal of Gastroenterology (2025). doi:10.14309/ajg.0000000000003332 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/105335
Title
Cost-Utility Analysis of Non-Invasive Tests to Initiate Hepatocellular Carcinoma Surveillance in Metabolic Dysfunction-Associated Steatotic Liver Disease
Corresponding Author(s)
Other Contributor(s)
Abstract
Background & Aims:Non-invasive tests (NITs), e.g. Fibrosis-4 Index (FIB-4) and vibration-controlled elastography (VCTE), have been used to identify metabolic dysfunction-associated steatotic liver disease (MASLD) patients at high risks for hepatocellular carcinoma (HCC). This study investigates the cost-effectiveness of NITs to identify MASLD patients with advanced liver fibrosis and initiate HCC surveillance.Methods:A cost-utility analysis using a Markov model compared no use of NITs with three NIT strategies: 1) FIB-4 and VCTE (FIB-4/VCTE), 2) FIB-4 alone, and 3) VCTE alone to identify advanced liver fibrosis and initiate HCC surveillance with biannual ultrasonography with alpha-fetoprotein in 4 MASLD populations: 1) general MASLD patients, 2) MASLD patients with body mass index (BMI) >30 kg/m2, 3) MASLD patients with diabetes, and 4) MASLD patients with three metabolic traits (diabetes, hypertension and BMI >30).Results:FIB-4/VCTE was the most cost-effective approach across all groups, showing the lowest ICER, followed by FIB-4 alone and VCTE alone. In the general MASLD population, both FIB-4/VCTE and FIB-4 alone were cost-effective in the US, while only FIB-4/VCTE was cost-effective in Thailand. For MASLD patients with BMI >30, all strategies were cost-effective in the US, while only FIB-4/VCTE was cost-effective in Thailand. In MASLD patients with diabetes or 3 metabolic traits, all strategies were cost-effective in the US, while FIB-4/VCTE and FIB-4 alone were cost-effective in Thailand.Conclusions:Using FIB-4/VCTE to initiate HCC surveillance is cost-effective for MASLD patients. If VCTE is unavailable, FIB-4 alone is a cost-effective alternative for MASLD patients with diabetes or 3 metabolic traits.