TOPLINE:

AI-based screening paired with transient elastography was cost-effective for detecting advanced liver fibrosis in at-risk adults with metabolic dysfunction-associated steatotic liver disease (MASLD), particularly when combined with semaglutide therapy.

METHODOLOGY:

• MASLD is often undetected until advanced fibrosis. AI-based risk-stratification tools have emerged as promising alternatives to standard approaches such as liver biopsy and Fibrosis-4 (FIB-4) index scoring for detecting advanced fibrosis, but their economic value relative to existing strategies remains uncertain.
• Researchers conducted a cost-effectiveness analysis of an AI-based risk-stratification tool combined with transient elastography and compared it with alternative screening strategies and no screening to identify US adults at risk for MASLD with advanced fibrosis.
• They utilized a discrete-time Markov model to simulate MASLD progression over a 10-year horizon from the US payer perspective, applying a 3% discount rate on costs and health outcomes annually.
• To evaluate liver fibrosis detection strategies, four screening approaches were compared: AI combined with transient elastography, FIB-4 index scoring combined with transient elastography, transient elastography only, and no screening. For individuals with biopsy‑confirmed advanced fibrosis, two separate treatment contexts were modeled: one using semaglutide and another using resmetirom.
• Primary outcomes were total costs, total quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) for each screening strategy compared with no screening.

TAKEAWAY:

• Compared with no screening, AI plus transient elastography yielded an incremental gain of 0.107 QALYs in the semaglutide treatment context at an additional cost of $4175, resulting in an ICER of $38,916 per QALY; however, in the resmetirom context, it produced the same QALY gain at an incremental cost of $8130, corresponding to an ICER of $76,141 per QALY.
• For FIB-4 index scoring combined with transient elastography, the additional cost was $6117 with semaglutide and $10,943 with resmetirom, with incremental QALY gains of 0.084 for both, yielding ICERs of $72,502 per QALY for semaglutide and $130,672 per QALY for resmetirom.
• Transient elastography-only screening yielded incremental QALY gains of 0.087 and 0.086 at an incremental cost of $6416 and $13,119 with semaglutide and resmetirom, respectively, resulting in ICERs of $74,027 per QALY for semaglutide and $152,894 per QALY for resmetirom.
• At a willingness-to-pay threshold of $100,000 per QALY, AI combined with transient elastography showed a more than 90% probability of being cost-effective with semaglutide and a more than 75% probability with resmetirom.

IN PRACTICE:

“[The study] data support the adoption of AI-based screening as a cost-effective approach to identify and treat individuals at risk for advanced fibrosis, with implications for payer policy and clinical practice,” the authors of the study wrote.

SOURCE:

This study was led by Basile Njei, Section of Digestive Diseases, Yale University, New Haven, Connecticut. It was published online in Digestive Diseases and Sciences.

LIMITATIONS: 

Model parameters were derived from the published literature, which may not have fully captured real-world variability in disease progression or resource utilization. As treatment effects for semaglutide and resmetirom were based on clinical trial data, long-term effectiveness and adherence in routine practice remained uncertain. The analysis adopted a payer perspective, which excluded indirect costs and broader societal impacts. 

DISCLOSURES:

No funding information was provided for the study. The authors disclosed having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.