OBJECTIVES: Over 7 million American adults have high-risk metabolic dysfunction-associated steatohepatitis (MASH). With the therapeutic landscape changing, eligible patients should be prescribed medication and monitored. MASH therapeutics are likely to be expensive with variable efficacy therefore treatment monitoring is necessary to identify and remove non-responders from treatment and reduce costs. Regular monitoring may also encourage therapy adherence. A 2-year budget impact of introducing mpMRI (cT1) to monitor response to thyroid hormone receptor treatment in MASH patients was assessed.

METHODS: A budget impact model was developed to estimate costs associated with introducing cT1 to monitor treatment response compared to standard of care (SoC) (LFTs), transient elastography (TE) and biopsy in 1,000 hypothetical patients. MASH regression was defined in two scenarios: (1) Fibrosis regression (Fibrosis decrease ≥ 1 + no worsening in NAFLD activity score (NAS)) and (2) NAS improvement (NAS decrease ≥ 2 + no worsening in fibrosis). Parameter sources include literature and calculations using longitudinal biopsy-paired data. The model uses a US setting payer perspective (2023 US dollars).

RESULTS: In scenario (1), introducing cT1 to identify non-responders was the least costly intervention ($18,454,200) compared to SoC ($38,000,000), TE ($25,584,400) and biopsy ($23,140,000) leading to a minimum 2-year cost savings of $4,685,800. This was consistent with scenario (2) whereby the cost of introducing cT1 was the least costly intervention ($20,593,200, SoC: $38,000,000, TE: $26,821,675 and biopsy: $26,380,000) leading to a minimum 2-year cost savings of $6,228,475. Despite comparator tests (TE) being a cheaper intervention, driving forces such as poor repeatability led to inaccurate monitoring and increased costs.

CONCLUSIONS: Introducing cT1 as a non-invasive approach to monitoring treatment response in MASH may lead to a minimum 2-year cost savings of $4,685,800 for 1,000 patients, reducing unnecessary pharmacotherapy use, ensuring that patients are treated appropriately, receiving the right treatment for the right amount of time.