Cost of Metabolic Dysfunction-Associated Steatotic Liver Disease Screening Among All People Living With Diabetes in Six Countries
Por:
Lazarus, JV, Agirre-Garrido, L, Miralles-Sanchez, JE, Manolas, MI, Tacke, F, Villela-Nogueira, CA, Al-Omar, HA, Alqahtani, SA, Alzubaidi, LMY, Bansal, M, Cusi, K, Isaacs, SD, Mauricio, D, Miyake, T, Moreira, RO, Nakazawa, S, Pannain, S, Pericàs, JM, Roden, M, Takahashi, H, Brachowicz, N
Publicada:
5 nov 2025
Resumen:
Background and Aims Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), are highly prevalent among people living with type 2 diabetes, with estimated rates of 65.4% and 31.6%, respectively, globally. This study aimed to estimate the direct healthcare costs of two MASLD and MASH screening strategies among all people living with diabetes in Brazil, Germany, Japan, the Kingdom of Saudi Arabia (KSA), Spain and the United States (US), from 2026 to 2030.Methods Strategy 1 consisted of a one-time universal screening of all adults living with diabetes. Strategy 2 involved biennial retesting of individuals who initially tested negative. The Fibrosis-4 (FIB-4) index was used as the first line test, followed by the Enhanced Liver Fibrosis (ELF) test or vibration-controlled transient elastography (VCTE) for confirmatory assessment. Implementation costs were estimated based on the country-specific prevalence of diabetes and included positive price variations that were aligned to monetary policy targets.Results Over 5 years, the estimated costs of Strategy 1 ranged from R$0.7-1.3 billion for Brazil, 346-617 million for Germany, & YEN;80-172 billion for Japan, SAR 3.7-6.0 billion for the KSA, 591-949 million for Spain and $2.7-15.2 billion for the US. Strategy 2 resulted in higher costs, ranging from R$1.2-2.0 billion for Brazil, 528-940 million for Germany, & YEN;121-262 billion for Japan, SAR 5.7-9.2 billion for the KSA, 0.9-1.4 billion for Spain and $4.1-23 billion for the US.Conclusions This study provides valuable guidance for policymakers and healthcare managers to integrate liver fibrosis screening strategies for people living with diabetes into national health budgets.
Filiaciones:
Lazarus, JV:
CUNY, Grad Sch Publ Hlth & Hlth Policy CUNY SPH, New York, NY 10017 USA
Barcelona Inst Global Hlth ISGlobal, Barcelona, Spain
Univ Barcelona, Fac Med & Hlth Sci, Barcelona, Spain
Manolas, MI:
Weill Cornell Med, Div Endocrinol Diabet & Metab, New York, NY USA
Tacke, F:
Charite Univ Med Berlin, Dept Hepatol & Gastroenterol, Campus Virchow Klinikum, Berlin, Germany
Campus Charite Mitte, Berlin, Germany
Alqahtani, SA:
King Faisal Specialist Hosp & Res Ctr, Liver Digest & Lifestyle Res Sect, Riyadh, Saudi Arabia
King Faisal Specialist Hosp & Res Ctr, Organ Transplant Ctr Excellence, Riyadh, Saudi Arabia
Weill Cornell Med, Div Gastroenterol & Hepatol, New York, NY USA
Alzubaidi, LMY:
Minist Hlth, Therapeut Deputyship, Riyadh, Saudi Arabia
Bansal, M:
Icahn Sch Med Mt Sinai, Div Hepatol, New York, NY USA
Cusi, K:
Univ Florida, Div Endocrinol Diabet & Metab, Gainesville, FL USA
Isaacs, SD:
Emory Univ, Sch Med, Div Endocrinol Metab & Lipids, Atlanta, GA USA
Mauricio, D:
Hosp Santa Creu & Sant Pau, Dept Endocrinol & Nutr, Barcelona, Spain
Inst Salud Carlos III ISCIII, CIBER Diabet & Associated Metab Dis CIBERDEM, ID CB15 00071, Madrid, Spain
Cent Univ Catalonia, Univ Vic, Dept Med, Vic, Spain
Inst Univ Invest Atencio Primaria Jordi Gol, DAP Cat Grp, Unitat Suport Recerca Barcelona Ciutat, Barcelona, Spain
Miyake, T:
Ehime Univ, Grad Sch Med, Dept Gastroenterol & Metabol, Toon, Ehime, Japan
Moreira, RO:
Inst Estadual Diabet & Endocrinol Luiz Caprigl IED, Rio De Janeiro, Brazil
Nakazawa, S:
Tokai Univ, Sch Med, Dept Prevent Med, Isehara, Kanagawa, Japan
Pannain, S:
Univ Chicago Med, Sect Endocrinol Diabet & Metab, Chicago, IL USA
Pericàs, JM:
Univ Autonoma Barcelona, Vall Dhebron Univ Hosp, Vall Dhebron Inst Res, Liver Unit, Barcelona, Spain
Johns Hopkins Univ, Pompeu Fabra Univ Publ Policy Ctr JHU UPF PPC, UPF Barcelona Sch Management UPF BSM, Barcelona, Spain
Roden, M:
Heinrich Heine Univ Dusseldorf, German Diabet Ctr DDZ, Inst Clin Diabetol, Leibniz Ctr Diabet Res, Dusseldorf, Germany
German Ctr Diabet Res DZD, Munchen Neuherberg, Germany
Heinrich Heine Univ Dusseldorf, Med Fac, Dept Endocrinol & Diabetol, Dusseldorf, Germany
Heinrich Heine Univ Dusseldorf, Univ Hosp Dusseldorf, Dusseldorf, Germany
Takahashi, H:
Saga Univ, Saga Med Sch, Dept Internal Med, Saga, Japan
Brachowicz, N:
Barcelona Inst Global Hlth ISGlobal, Barcelona, Spain
Univ Fed Rio de Janeiro, Sch Med, Internal Med Dept, Rio De Janeiro, Brazil
King Saud Univ, Coll Pharm, Dept Clin Pharm, Riyadh, Saudi Arabia
Green Submitted, hybrid
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