Presentation (CTI)

OBJECTIVES: The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing with a projected global prevalence of 55% by 2040. Metabolic dysfunction-associated steatohepatitis (MASH) prevalence is also increasing. UK guidelines for managing MASLD are changing, with new therapies being assessed by NICE. Individual cost-effectiveness analyses have been completed for therapies but there is limited evidence on the most efficient methods for identifying those eligible for treatment. This analysis aims to assess the cost-effectiveness of multiparametric MRI (corrected T1 (cT1)) in a UK care setting in patients with MASH that may be eligible for resmetirom treatment.
METHODS: A hypothetical cohort of 1,000 patients with suspected MASH were modelled using an initial decision tree and Markov model structure. Three decision trees were modelled: 1. vibration controlled transient elastography (VCTE) only, 2. cT1 only, and 3. VCTE followed by cT1. Outcomes of interest were the lifetime number of decompensated cirrhosis (DCC) cases, the lifetime number of hepatocellular carcinoma (HCC) cases, total costs, total utility and incremental cost-effectiveness ratio (ICER).
RESULTS: Decision trees 1 and 2 resulted in 36 cases of DCC over the model horizon. Decision tree 2 resulted in a greater utility and an increase in total costs of approximately £1,300 compared to decision tree 1. Decision tree 3 resulted in the lowest number of DCC and HCC cases and the greatest utility, however had the highest total costs (£220,478 vs £215,183 (DT2) vs £213,870 (DT1)). Compared to VCTE only, cT1 only had an ICER of £34,647 per QALY gained and VCTE followed by cT1 had an ICER of £35,479 per QALY gained.
CONCLUSIONS: The implemenation of mpMRI in a UK care setting was found to cost-effective compared to VCTE, highlighting the potential to increase efficiency in a patient pathway where new treatments may be introduced.