Cost-Effectiveness of MASH Diagnosis and Management Approaches Among Those With Type 2 Diabetes

作者：Jeffrey V. Lazarus, Leire Agirre‐Garrido, Luis Antonio Díaz, Pojsakorn Danpanichkul, Sokoine Lesikari Kivuyo, Loreta A. Kondili, Hannes Hagström, Hirokazu Takahashi, Juan Manuel Pericàs, C Wendy Spearman, Claudia Pinto Marques Souza de Oliveira, Cristiane Alves Villela‐Nogueira, Jörn Markus Schattenberg, Emilie Toresson Grip, Naim Alkhouri, Andrea Marcellusi, Henry E. Mark, Alina M. Allen, Nathalie Carvalho Leite, Hussain Abdulrahman Al‐Omar, Saleh A. Alqahtani, Nicolai Brachowicz · 发表于：JAMA Network Open · 年份：2025 · DOI：10.1001/jamanetworkopen.2025.42750 · 被引用次数：10 · 研究领域：Liver Disease Diagnosis and Treatment、Hepatitis C virus research、Diabetes, Cardiovascular Risks, and Lipoproteins

Importance: Metabolic dysfunction-associated steatohepatitis (MASH) represents a high, underprioritized burden among noncommunicable diseases (NCDs) and people living with type 2 diabetes (T2D). Objective: To identify cost-effective management approaches to prevent, detect, and treat MASH and liver fibrosis in people living with T2D. Design, Setting, and Participants: This economic evaluation consisted of a generalized cost-effectiveness analysis (GCEA) that was conducted for 12 countries (Brazil, Chile, Germany, Italy, Japan, Saudi Arabia, South Africa, Spain, Sweden, Tanzania, Thailand, and the United States), across all 6 World Health Organization (WHO) regions. A cohort state-transition model simulated liver disease development and its impact on a synthetic cohort, aged 19 years and older and living with T2D, over their lifespan across 10 liver health states. Exposures: Using an 80% coverage level, 14 management approaches were compared, including screening via the Fibrosis-4 (FIB-4) test and Enhanced Liver Fibrosis (ELF) test or vibration-controlled transient elastography (VCTE) as well as treatment with pharmacological and nonpharmacological interventions. Main Outcomes and Measures: The main outcomes were the average cost-effectiveness ratios (ACERs) and the incremental cost-effectiveness ratios (ICERs), which were used to construct care expansion paths by ranking the management approaches in order of cost-effectiveness. The main measures were the total incremental cos...