{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:46:44Z","timestamp":1793400404623,"version":"4.5.0"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Metabolic dysfunction\u2013associated steatohepatitis (MASH) represents a high, underprioritized burden among noncommunicable diseases (NCDs) and people living with type 2 diabetes (T2D).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To identify cost-effective management approaches to prevent, detect, and treat MASH and liver fibrosis in people living with T2D.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This economic evaluation consisted of a generalized cost-effectiveness analysis (GCEA) that was conducted for 12 countries (Brazil, Chile, Germany, Italy, Japan, Saudi Arabia, South Africa, Spain, Sweden, Tanzania, Thailand, and the United States), across all 6 World Health Organization (WHO) regions. A cohort state-transition model simulated liver disease development and its impact on a synthetic cohort, aged 19 years and older and living with T2D, over their lifespan across 10 liver health states.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Using an 80% coverage level, 14 management approaches were compared, including screening via the Fibrosis-4 (FIB-4) test and Enhanced Liver Fibrosis (ELF) test or vibration-controlled transient elastography (VCTE) as well as treatment with pharmacological and nonpharmacological interventions.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The main outcomes were the average cost-effectiveness ratios (ACERs) and the incremental cost-effectiveness ratios (ICERs), which were used to construct care expansion paths by ranking the management approaches in order of cost-effectiveness. The main measures were the total incremental costs and the total incremental quality-adjusted life-years (QALYs) of each intervention.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In this GCEA, the outcomes were evaluated with respect to country-specific willingness-to-pay thresholds. The standard of care had the lowest ACERs in 8 countries (not in Chile, Germany, Saudi Arabia, or the United States). Treatment with intensive lifestyle interventions (ILIs), after screening via ELF or VCTE, was cost-effective in all countries. ILIs and treatment with semaglutide was cost-effective in 11 countries (not in Tanzania); ILIs and treatment with resmetirom was cost-effective in 8 countries (not in Brazil, South Africa, Tanzania, or Thailand).<\/jats:p>\n <\/jats:sec>\n \n Conclusion and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.42750","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T16:31:06Z","timestamp":1762446666000},"page":"e2542750","source":"Crossref","is-referenced-by-count":17,"title":["Cost-Effectiveness of MASH Diagnosis and Management Approaches Among Those With Type 2 Diabetes"],"prefix":"10.1001","volume":"8","author":[{"given":"Jeffrey V.","family":"Lazarus","sequence":"first","affiliation":[{"name":"City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York"},{"name":"Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain"},{"name":"Faculty of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leire","family":"Agirre-Garrido","sequence":"additional","affiliation":[{"name":"Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Antonio","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Departamento de Gastroenterolog\u00eda, Escuela de Medicina, Pontificia Universidad Cat\u00f3lica de Chile, Santiago, Chile"},{"name":"Observatorio Multic\u00e9ntrico de Enfermedades Gastrointestinales, OMEGA, Santiago, Chile"},{"name":"MASLD Research Center, Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pojsakorn","family":"Danpanichkul","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sokoine L.","family":"Kivuyo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain"},{"name":"National Institutes for Medical Research, Dar es Salaam, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loreta A.","family":"Kondili","sequence":"additional","affiliation":[{"name":"National Center for Global Health, Istituto Superiore di Sanit\u00e0, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Hagstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden"},{"name":"Division of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Liver Center, Saga University Hospital, Saga City, Saga, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan M.","family":"Peric\u00e0s","sequence":"additional","affiliation":[{"name":"Liver Unit, Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Institute for Research, Universitat Aut\u00f2noma de Barcelona, Centros de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd), Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Wendy","family":"Spearman","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia P.","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculdade de Medicina da Universidade de S\u00e3o Paulo (LIM07), S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiane A.","family":"Villela-Nogueira","sequence":"additional","affiliation":[{"name":"School of Medicine, Hepatology Division, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rn M.","family":"Schattenberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Saarland University Medical Centre, Homburg, 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