Noninvasive tests and diagnostic pathways to MASH diagnosis in the United States: a retrospective observational study.

IF 2.9 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Economics Pub Date : 2025-12-01 Epub Date: 2025-02-28 DOI:10.1080/13696998.2025.2468582
Semiu O Gbadamosi, Kristin A Evans, Brenna L Brady, Anthony Hoovler
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引用次数: 0

Abstract

Aim: Although liver biopsy is considered the most reliable diagnostic tool for metabolic dysfunction-associated steatohepatitis (MASH), it is invasive and can be costly. Clinicians are increasingly relying on routine biomarkers and other noninvasive tests (NITs) for diagnosis. We examined real-world diagnostic pathways for patients newly diagnosed with MASH with a primary focus on NITs.

Materials and methods: This retrospective, observational study analyzed healthcare claims data (Merative MarketScan Commercial and Medicare Databases) from patients in the United States newly diagnosed with MASH from October 1, 2016, to March 31, 2023. Patients ≥18 years old with ≥12 months of continuous enrollment with medical and pharmacy benefits prior to diagnosis were included. Diagnostic pathways leading up to MASH diagnosis, including NITs (blood-based and imaging-based tests) and liver biopsies were assessed. Prevalence of comorbid conditions, MASH-associated medication use, and the diagnosing physician specialty were also examined.

Results: A total of 18,396 patients were included in the analysis. Routine laboratory tests (alanine aminotransferase [ALT], albumin, aspartate aminotransferase [AST], cholesterol, complete blood count, and hemoglobin A1c) were performed among ≥70% of patients prior to MASH diagnosis, including 89% of patients with a liver enzyme test (ALT and/or AST). More than 75% of patients had necessary laboratory tests to calculate AST to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scores. The most common imaging performed was ultrasound (62%); liver biopsy was only performed in 10% of patients. There was a high prevalence of cardio metabolic risk factors such as hyperlipidemia (66%), hypertension (62%), obesity (58%), type 2 diabetes (40%), and cardiovascular disease (21%). Nearly half of the patients (49%) were diagnosed by a primary care physician.

Limitations and conclusions: This study highlights real-world diagnostic pathways among patients newly diagnosed with MASH, supporting previous findings that liver biopsies are infrequently used in favor of noninvasive methods.

在美国,非侵入性检查和MASH诊断途径:一项回顾性观察研究。
目的:虽然肝活检被认为是代谢功能障碍相关脂肪性肝炎(MASH)最可靠的诊断工具,但它是侵入性的,并且可能昂贵。临床医生越来越依赖常规生物标志物和其他非侵入性测试(nit)进行诊断。我们研究了新诊断为MASH的患者的真实诊断途径,主要关注nit。材料和方法:本回顾性观察性研究分析了2016年10月1日至2023年3月31日美国新诊断为MASH的患者的医疗索赔数据(Merative MarketScan商业和医疗保险数据库)。患者年龄≥18岁,诊断前连续入组≥12个月,享受医疗和药学福利。评估导致MASH诊断的诊断途径,包括NITs(基于血液和基于成像的检查)和肝脏活检。同时还检查了合并症的患病率、与mash相关的药物使用和诊断医师专业。结果:共纳入18396例患者。≥70%的患者在诊断为MASH之前进行了常规实验室检查(谷丙转氨酶[ALT]、白蛋白、天冬氨酸转氨酶[AST]、胆固醇、全血细胞计数和血红蛋白A1c),其中89%的患者进行了肝酶检查(ALT和/或AST)。超过75%的患者进行了必要的实验室检查,以计算AST与血小板比值指数(APRI)和纤维化-4指数(FIB-4)评分。最常见的影像学检查是超声(62%);只有10%的患者进行了肝活检。心脏代谢危险因素的患病率很高,如高脂血症(66%)、高血压(62%)、肥胖(58%)、2型糖尿病(40%)和心血管疾病(21%)。近一半的患者(49%)是由初级保健医生诊断的。局限性和结论:本研究强调了新诊断为MASH的患者的真实诊断途径,支持了先前的发现,即肝活检很少用于非侵入性方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Medical Economics
Journal of Medical Economics HEALTH CARE SCIENCES & SERVICES-MEDICINE, GENERAL & INTERNAL
CiteScore
4.50
自引率
4.20%
发文量
122
期刊介绍: Journal of Medical Economics'' mission is to provide ethical, unbiased and rapid publication of quality content that is validated by rigorous peer review. The aim of Journal of Medical Economics is to serve the information needs of the pharmacoeconomics and healthcare research community, to help translate research advances into patient care and be a leader in transparency/disclosure by facilitating a collaborative and honest approach to publication. Journal of Medical Economics publishes high-quality economic assessments of novel therapeutic and device interventions for an international audience
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