Presentation (CTI)

OBJECTIVES: In the evaluation of Metabolic Dysfunction-Associated Steatohepatitis (MASH), non-invasive tests (NITs) have been intensively investigated to address the challenges associated with liver biopsy such as expensiveness and invasiveness. This study aims to compare the diagnosis cost and one-year lifetime liver disease management costs in Japan between intervention (diagnosing with NITs only) versus comparator (diagnosing with liver biopsy following NITs screening).
METHODS: Following ISPOR guidelines on good practices for BIA (2007), diagnosis costs and one-year lifetime liver disease management costs were computed for approximately 540,000 MASH prevalence in Japan, using a decision tree followed by a Markov model. The decision tree classified subjects into either less advanced (≤F2) or advanced (≥F3) liver disease categories based on the sensitivity and specificity of NITs as reported in previous studies. Liver biopsy was assumed to be 100% accurate. Diagnosed patients then transitioned to a Markov model, wherein liver disease management costs were incurred according to their health states as they progressed through the Markov cycles.
Three NITs scenarios were considered: FIB-4 combined with Type IV collagen 7S (T4C7S), a reimbursed diagnosis testing in Japan, for base case; FIB-4 combined with ELF and VCTE for alternative 1; FIB-4 combined with T4C7S and VCTE for alternative 2.
RESULTS: The use of NITs was cost-saving than comparator in all NIT scenarios despite the unnecessary management cost incurred by higher number of patients with ≤F2 misclassified as ≥F3. In base case, intervention resulted in reduction in the total of diagnosis cost and one-year lifetime liver disease management costs by ¥8.19 billion per Japanese population of 124 million than comparator.
CONCLUSIONS: It was demonstrated that diagnosing with NIT only costs less than NITs followed by liver biopsy confirmation. NITs can be considered to be a good alternative to liver biopsy.