Document Type
Article
Publication Date
3-13-2026
Abstract
BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) remains a global public health threat. With emerging effective pharmacologic therapies, early identification of significant fibrosis in primary care is critical. We evaluated the cost-effectiveness of blood-based noninvasive tests incorporating real-world diagnostic performance in the contemporary MASLD treatment era.
METHODS: We developed a decision-analytic model for MASLD natural history and treatment to compare 6 noninvasive test strategies using Fibrosis-4 (FIB-4) and/or enhanced liver fibrosis (ELF) tests at varying cutoffs. Patients identified with significant fibrosis were referred for hepatology staging (biopsy and/or imaging-based), and eligible individuals were considered for Resmetirom ($47,400/y; mean duration: 1.6-1.8 year). Model parameters were informed by a real-world cohort (n = 400) of high-risk primary care patients with suspected MASLD who underwent both tests. Outcomes included quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios, and adverse liver outcomes averted.
RESULTS: The modeled population had a mean age of 64 years, mean body mass index of 32 kg/m2, with 82% having type-2 diabetes and 15% significant fibrosis. Sequential screening with ELF (cutoff 9.80) following indeterminate FIB-4 (1.3-2.67) was the most cost-effective, yielding 8.610 QALYs and $96,990 in lifetime costs at a $100,000/QALY threshold. ELF-alone screening at a 9.00 cutoff maximized QALYs and individuals treated but increased unnecessary referrals. Resmetirom cost was most influential on results: if cost fell below $11,570/y (base case, $47,400/y), ELF-alone screening became the preferred strategy. Findings remained robust across sensitivity analyses, including in low-risk populations.
CONCLUSION: By integrating real-world diagnostic performance with new MASLD therapies, this translational modeling study identifies a scalable, cost-effective fibrosis screening pathway using FIB-4 and ELF. These findings support implementation of blood-based fibrosis screening in general primary care populations.
Recommended Citation
Chen, Wanyi; Chang, Stephanie T.; Cheung, Ramsey C.; Chalfin, Donald B.; Sangha, Kinpritma; Zoe Kao, Szu-Yu; and Boltyenkov, Artem T., "Cost-Effectiveness of Blood-Based Fibrosis Screening in High-Risk Metabolic Liver Diseases With Emerging Therapies" (2026). College of Population Health Faculty Papers. Paper 245.
https://jdc.jefferson.edu/healthpolicyfaculty/245
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Language
English
Comments
This article is the author’s final published version in Gastro Hep Advances, Volume 5, Issue 5, 2026, Article number 100923.
The published version is available at https://doi.org/10.1016/j.gastha.2026.100923. Copyright © 2026 The Authors.