Cost-effectiveness analysis of MASLD screening using FIB-4 based two-step algorithm in the medical check-up

Screening for metabolic dysfunction-associated steatotic liver disease (MASLD) across the entire general population is not currently a recommended strategy. However, it is not uncommon to receive a medical check-up or health check-up for a various of reasons. We tried to investigate whether advanced fibrosis screening in MASLD patients is cost-effective for adults aged 40-49 years during medical or health check-up. The target group for analysis was adults who received medical check-ups for various reasons in the United States. We constructed a hybrid model of the decision tree model and Markov model to compare expected costs and quality-adjusted life-years (QALYs) between 'screening' and 'no screening' groups from healthcare system perspectives. Patients diagnosed MASLD with advanced fibrosis by FIB4 and VCTE were given intensive lifestyle intervention (ILI). The incremental cost-effectiveness ratio (ICER) was calculated for a 30-year horizon. Assuming effect of ILI is limited to regression of liver fibrosis, ICER of the FIB-4-based two steps algorithm was $103,405 per QALY in adults aged 40-49 years, which was slightly above the threshold value ($100,000/QALY). And in those in adults aged 50-59 and 60-69 years, the ICER was $137,593 and $197,901 per QALY, respectively. If we assume the effect of ILI can improve liver fibrosis as well as cardiovascular disease events, ICERs of screening in aged 40-49 and 50-59 years were $74,596, and $95,974 per QALY, respectively. In an analysis that included additional positive effect on extrahepatic cancer by ILI, estimated ICERs were below the threshold in those in aged 40-49 and 50-59 years. Advanced fibrosis screening in MASLD patients using the FIB-4-based two-step algorithm and ILI was cost-effective for adults aged 40-49 years, taking into account both liver fibrosis and cardiovascular disease.