OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed in patients with metabolic syndrome (MetS). Ultrasonography is a standard method for screening NAFLD in clinical practice. However, its limitation are costly and lack of human resources. Noninvasive predicting scores of NAFLD are more useful for screening of NAFLD. This study aimed to evaluate cost-effectivenss of these scores for prediction of NAFLD among MetS patients in Thailand as one of low- and middle-income countries.

METHODS: The sensitivity and specificity of fatty liver index (FLI), lipid accumulation product (LAP), hepatic steatosis index (HIS), and NAFLD-MS score were analyzed among a total of 499 Thai MetS patients. A decision tree coupled with Markov model was used to estimate lifetime costs and health benefits of these scores using a societal perspective. The input parameters were obtained from Thai health care databases and systematic literature review. Results were compared between 4 scores and reported as incremental cost-effectiveness ratios (ICERs) in 2017 US Dollars (USD) per quality-adjusted life year (QALY) gained.

RESULTS: NAFLD was detected in 68% of total MetS patients. At the Thai ceiling threshold of societal willingness-to-pay of 4,706 USD, at low cutoff point; screening ultrasonography for moderate- and high-risk groups, all scores were cost-effective when compared to no screening. HSI is the best buy option with an ICER of 2,748 USD/QALY gained. However, at high cutoff point; screening ultrasonography for only high-risk group, LAP is better than other scores with an ICER of 2,073 USD/QALY gained.

CONCLUSIONS: Noninvasive scores were cost-effective for screening of NAFLD among MetS patients. Patients with moderate- and high-risk of NAFLD by scoring system are recommended for ultrasonography confirmation. The patients will receive early diagnosis with good value of money and overuse of ultrasonography can be avoided. Our findings can be used as part for policy decision making in NAFLD screening program.