Presentation (CTI)

OBJECTIVES: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has a global adult prevalence of 38% reaching 62% in patients with type 2 diabetes. The current gold standard for assessing liver health is an invasive liver biopsy (LB). With resmetirom now being made available to Metabolic Dysfunction-Associated Steatohepatitis (MASH) patients there needs to be a safe way to risk stratify and monitor these patients to avoid the well-documented risks of major and minor complications with LB. Multiparametric MRI (mpMRI) is one such noninvasive alternative to LB. This analysis aimed to calculate the incidence and cost of complications in patients risk stratified for and prescribed resmetirom using both LB and mpMRI.
METHODS: This analysis was built on previous work presenting the costs associated with diagnosing and monitoring patients prescribed resmetirom treatment. 5,000 hypothetical patients were screened for treatment assignment and monitored every six months for two years. Complication incidence and costs were taken from literature and publicly available healthcare costing templates.
RESULTS: Per 5,000 screened for treatment eligibility, there were 761 minor and 195 major LB complications, including 1 death over the 2-year period. A total of 27 patients experienced moderate or severe pain, 38 experienced major bleeding, and 52 patients had to be hospitalized. The total complication cost for LB over the 2 years was almost $1,500,000 whereas costs associated with mpMRI complications were $55,328. This cost was due to the repetition of scans for 58 patients because of failed data acquisition.
CONCLUSIONS: The inclusion of mpMRI as opposed to liver biopsy to risk stratify and monitor patients undergoing resmetirom therapy for MASH decreases the incidence and cost of complications associated with this treatment. Further, it highlights potential benefits to morbidity and even mortality of using mpMRI as a noninvasive alternative to LB.