TARGETED LITERATURE REVIEW OF DIAGNOSIS, SCREENING AND HEALTH-ECONOMIC MODELS OF METABOLIC DYSFUNCTION-ASSOCIATED STEATOHEPATITIS
Author(s)
Preety Gautam, MSc1, Brendan Clark, PharmD2, Philipp Markus Hofheinz, MSc1, Tanushree Chaudhary Pavithran, MSc3, Ketevan Rtveladze, MSc4, Jahangir Nabi Mir, MSc3.
1Boehringer Ingelheim International GmbH, Ingelheim, Germany, 2Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA, 3IQVIA, Gurugram, Haryana, India, 4IQVIA, London, United Kingdom.
1Boehringer Ingelheim International GmbH, Ingelheim, Germany, 2Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA, 3IQVIA, Gurugram, Haryana, India, 4IQVIA, London, United Kingdom.
OBJECTIVES: Despite the growing disease burden, screening and diagnosis of MASH are still substantially low. This TLR aimed to assess diagnosis rates and performance of currently used screening and diagnostic strategies and health-economic evidence supporting non-invasive screening approaches.
METHODS: Embase, PubMed, congress websites and HTA body websites were searched for observational studies and economic evaluations published between 2020 to 2026. The population of interest were adults with risk or diagnosed with MASH.
RESULTS: Eight health-economic modelling studies and 21 screening and diagnosis practice studies were retrieved across US, Europe and Asia. Real-world diagnosis rates were far below the expected prevalence with ~80% of the prevalent MASH population reportedly undiagnosed, indicating substantial under-recognition. Most diagnoses occurred in primary care (49%) or general gastroenterology (26%) suggesting that MASH identification often occurs within broader healthcare settings rather than through specialist care. Risk-based case-finding rather than universal screening was strongly supported in studies and AASLD and EASL-EASD-EASO guidelines. However, it has been observed that MASH is diagnosed much later than optimal. For most of these patients, the data needed for early identification, for example laboratory results and imaging reports, are already available in their medical history years before they receive an official diagnosis. Sequential non-invasive strategies provided the most favourable balance between costs and outcomes; in one study of high-risk populations, Fibrosis-4 Index followed by vibration-controlled transient elastography yielded ICERs ranging from $78,647-$84,874/QALY gained, remaining below US willingness-to-pay thresholds ($100,000/QALY gained). Progression toward advanced fibrosis, cirrhosis and end-stage liver disease increased long-term healthcare costs and resource use, supporting the economic value of earlier non-invasive identification and intervention.
CONCLUSIONS: The evidence demonstrates that MASH remains underdiagnosed and sequential non-invasive-based case-finding is the most practical and economically favourable approach for early identification in high-risk populations. The main driver of long-term MASH healthcare burden was progression to advanced stages.
METHODS: Embase, PubMed, congress websites and HTA body websites were searched for observational studies and economic evaluations published between 2020 to 2026. The population of interest were adults with risk or diagnosed with MASH.
RESULTS: Eight health-economic modelling studies and 21 screening and diagnosis practice studies were retrieved across US, Europe and Asia. Real-world diagnosis rates were far below the expected prevalence with ~80% of the prevalent MASH population reportedly undiagnosed, indicating substantial under-recognition. Most diagnoses occurred in primary care (49%) or general gastroenterology (26%) suggesting that MASH identification often occurs within broader healthcare settings rather than through specialist care. Risk-based case-finding rather than universal screening was strongly supported in studies and AASLD and EASL-EASD-EASO guidelines. However, it has been observed that MASH is diagnosed much later than optimal. For most of these patients, the data needed for early identification, for example laboratory results and imaging reports, are already available in their medical history years before they receive an official diagnosis. Sequential non-invasive strategies provided the most favourable balance between costs and outcomes; in one study of high-risk populations, Fibrosis-4 Index followed by vibration-controlled transient elastography yielded ICERs ranging from $78,647-$84,874/QALY gained, remaining below US willingness-to-pay thresholds ($100,000/QALY gained). Progression toward advanced fibrosis, cirrhosis and end-stage liver disease increased long-term healthcare costs and resource use, supporting the economic value of earlier non-invasive identification and intervention.
CONCLUSIONS: The evidence demonstrates that MASH remains underdiagnosed and sequential non-invasive-based case-finding is the most practical and economically favourable approach for early identification in high-risk populations. The main driver of long-term MASH healthcare burden was progression to advanced stages.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
SA67
Topic
Health Service Delivery & Process of Care, Study Approaches
Topic Subcategory
Literature Review & Synthesis
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)