Screening for MASLD and Advanced Fibrosis Among Patients With Obesity: A Cost-Effectiveness Analysis

IF 4.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity Pub Date : 2025-08-13 DOI:10.1002/oby.70005

Arpan Mohanty, Yin Wang, Charles Stoecker

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Abstract

Objective

The study aimed to compare the cost-effectiveness of various strategies for screening for MASLD-related advanced hepatic fibrosis (fibrosis stage > 2) using the fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM) by transient elastography (TE) in persons with obesity.

Methods

We created a decision-analytic model comparing three screening strategies: no screening, TE, and FIB-4 followed by TE. We used a Markov transition model to track liver state, with prevalence and transition probabilities specific to the population with obesity. If MASLD was detected, patients were treated with resmetirom.

Results

We found an incremental cost-effectiveness ratio (ICER) of $234,781 (95% CI: $232,581, $235,608) when comparing TE to no screening with a 10-year interval. We note the ICER of $234,673 (95% CI: $234,033, $235,072) when comparing TE to FIB-4+TE. In multivariate simulations, we found no screening was most likely to be cost-effective for willingness-to-pay for QALY below approximately $250,000.

Conclusions

Our results suggest routine screening for MASLD in obesity clinics is not cost-effective with resmetirom as the available treatment. A prescreening with FIB-4 before TE did not increase economic efficiency.

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肥胖症患者MASLD和晚期纤维化筛查：成本-效果分析

目的：本研究旨在比较肥胖症患者使用纤维化-4指数（FIB-4）和肝硬度测量（LSM）的肝纤维化（纤维化期>2）筛查masld相关晚期肝纤维化（纤维化期>2）的各种策略的成本效益。方法：我们建立了一个决策分析模型，比较三种筛查策略：不筛查、TE和FIB-4后TE。我们使用马尔可夫转移模型来跟踪肝脏状态，以及肥胖人群特有的患病率和转移概率。如果检测到MASLD，则给予雷美替康治疗。结果：我们发现，在10年的间隔时间内，将TE与未筛查进行比较，增量成本-效果比（ICER）为234,781美元（95% CI: 232,581美元，235,608美元）。当比较TE与FIB-4+TE时，我们注意到ICER为234,673美元（95% CI: 234,033美元，235,072美元）。在多变量模拟中，我们发现，对于QALY低于25万美元的患者来说，没有筛查是最具成本效益的。结论：我们的研究结果表明，在肥胖诊所常规筛查MASLD与雷司替罗作为可用的治疗是不划算的。在TE之前进行FIB-4预筛选并没有提高经济效率。

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

Obesity 医学-内分泌学与代谢

CiteScore

11.70

自引率

1.40%

发文量

261

审稿时长

2-4 weeks

期刊介绍： Obesity is the official journal of The Obesity Society and is the premier source of information for increasing knowledge, fostering translational research from basic to population science, and promoting better treatment for people with obesity. Obesity publishes important peer-reviewed research and cutting-edge reviews, commentaries, and public health and medical developments.