Cost-Effectiveness of MASH Diagnosis and Management Approaches Among Those With Type 2 Diabetes
Authors' conclusion
In this economic evaluation, screening followed by ILIs was found to be a cost-effective management approach for MASH and liver fibrosis among people living with T2D in all countries. Screening followed by pharmacological treatment was cost-effective in most countries. These results can inform health policy decision-making and further the development of WHO recommended interventions to address NCDs.
Study context
- Population
- Synthetic cohort aged 19 years and older living with T2D, modelled for Brazil, Chile, Germany, Italy, Japan, Saudi Arabia, South Africa, Spain, Sweden, Tanzania, Thailand and the United States12 countries
- Exposure
- 14 management approaches for MASH and liver fibrosis in T2D: screening (FIB-4 and Enhanced Liver Fibrosis (ELF) or vibration-controlled transient elastography (VCTE)) with pharmacological or nonpharmacological treatment
- Outcome
- ACERs and incremental cost-effectiveness ratios (ICERs) used to construct care expansion paths; total incremental costs and total incremental quality-adjusted life-years (QALYs) of each intervention
- Follow-up
- Lifespan
Methodological detailsgeneralized cost-effectiveness analysis, cohort state-transition model, synthetic cohort, 12 countries across all 6 World Health Organization (WHO) regions, 80% coverage level, lifetime horizon
- Generalized cost-effectiveness analysis
- Cohort state-transition model
- Synthetic cohort
- 12 countries across all 6 WHO regions
- 80% coverage level
- Lifetime horizon
Main finding
As reported in the abstract
Cost-effectiveness vs country-specific willingness-to-pay thresholds
- Standard of care had the lowest Average Cost-effectiveness Ratios (ACERs) (not in Chile, Germany, Saudi Arabia or the US)
- 8 countries
- Intensive lifestyle interventions (ILIs) after screening via ELF or VCTE cost-effective
- all countries
- ILIs and semaglutide cost-effective (not in Tanzania)
- 11 countries
- ILIs and resmetirom cost-effective (not in Brazil, South Africa, Tanzania or Thailand)
- 8 countries
Observational data: associations, not effects.
Original publication
Cost-Effectiveness of MASH Diagnosis and Management Approaches Among Those With Type 2 Diabetes. JAMA Netw Open. Published 3 November 2025. doi:10.
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