Screening for nonalcoholic steatohepatitis in individuals with type 2 diabetes: a cost-effectiveness analysis
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Background and aim Individuals with type 2 diabetes are at heightened risk for nonalcoholic fatty liver disease, which gives rise to nonalcoholic steatohepatitis (NASH) and cirrhosis. Yet, current guidelines do not recommend screening for NASH among these high-risk patients. Using a simulation model, we assessed the effectiveness and cost-effectiveness of screening diabetic patients for NASH.Methods A Markov model was constructed to compare two management strategies for 50-year-olds with diabetes. In the No Screening strategy, patients do not undergo screening, although NASH may be diagnosed incidentally over their lifetime. In the NASH Screening strategy, all patients receive a one-time screening ultrasound. Individuals with fatty infiltration on ultrasound then have a liver biopsy, and those found to have NASH receive medical therapy, which decreases progression to cirrhosis. Endpoints evaluated included quality-adjusted life years (QALYs) gained, costs, and incremental cost-effectiveness ratios (ICERs).Results Screening for NASH decreased the number of individuals who developed cirrhosis by 12.9 % and resulted in an 11.9 % decrease in liver-related deaths. However, screening resulted in 0.02 fewer QALYs, due to the disutility associated with treatment, and was therefore dominated by the No Screening strategy. When the model excluded this quality-of-life decrement, screening became cost-effective, at an ICER of $42,134 per QALY.Conclusions Screening for NASH may improve liver-related outcomes, but is not cost-effective at present, due to side effects of therapy. As better tolerated treatments for NASH become available, even with modest efficacy, screening for NASH will become cost-effective.
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Another study suggests that screening by abdominal ultrasound followed by liver biopsy is not cost-effective in individuals with T2D, though this approach deviates from usual practice.
“Likewise, another study suggests that screening by abdominal ultrasound followed by liver biopsy is not cost-effective in individuals with T2D, 134 though this approach deviates from usual practice.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [134]
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- Authors
- Corey, K. E., Klebanoff, M. J., Tramontano, A. C., Chung, R. T., & Hur, C.
- Affiliations
- Harvard University (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Corey, Kathleen E.
- Venue
- Digestive Diseases and Sciences
- Published
- 2016-01-29
- Volume
- 61
- Issue
- 7
- Pages
- 2108-2117
- ISSN
- 0163-2116 (ISSN-L)
- 1573-2568
- PMC
- PMC4920690
- OpenAlex
- W2259472883
- Cited by
- 84
- References
- 47
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 4 · 2023: 8 · 2022: 13 · 2021: 10 · 2020: 14 · 2019: 8 · 2018: 10 · 2017: 4 · 2016: 5
- FWCI
- 8.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Digestive Diseases and Sciences (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (K23 DK099422, K24 DK078772)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- nonalcoholic steatohepatitis, type 2 diabetes, cost-effectiveness, non-alcoholic fatty liver disease, liver cirrhosis, liver-related mortality, ultrasound screening, liver biopsy, NASH therapy, quality-adjusted life years, Markov model
- MeSH terms
- Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Humans, Markov Chains, Models, Biological, Risk Factors, Ultrasonography, Early Diagnosis, Non-alcoholic Fatty Liver Disease
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