Cost-utility and budget impact analyses of significant fibrosis detection in individuals with metabolic syndrome or obesity in Thailand

Abstract

Introduction Evidence on screening for significant fibrosis in individuals with metabolic syndrome or obesity at risk of metabolic dysfunction-associated steatotic liver disease is limited in low- and middle-income countries. We conducted a cost-utility analysis and a 5-year budget impact analysis of 3 one-time screening strategies versus no screening in Thai adults with metabolic syndrome or obesity. Methods We built a lifetime economic model from a societal perspective to estimate quality-adjusted life years (QALYs) and costs. Strategies were: (1) Fibrosis-4 index (FIB-4) followed by transient elastography (TE), (2) Steatosis-Associated Fibrosis Estimator score followed by TE, and (3) TE alone. Inputs came from a literature review and primary data analysis. Costs and outcomes were discounted at 3% annually. Incremental cost-effectiveness ratios (ICERs) were compared with a willingness-to-pay threshold of 160,000 THB (4,619 USD) per QALY gained. One-way and probabilistic sensitivity analyses were undertaken, and a 5-year budget impact analysis was performed from the payer perspective. Results In metabolic syndrome, FIB-4 + TE yielded an ICER of 104,588 THB (3,019 USD) per QALY gained versus no screening. The Steatosis-Associated Fibrosis Estimator score plus TE yielded 128,274 THB (3,703 USD). Extended dominance identified FIB-4 + TE as the sole cost-effective strategy. In obesity, all strategies were cost-effective, with TE alone preferred. The transition from fibrosis stage F3 to F4 most influenced ICERs. The probability that FIB-4 + TE was cost-effective ranged from 59% to 78%. Estimated annual budget impact over 5 years ranged from 564 to 2,314 million THB (16.3–66.8 million USD). Conclusions One-time screening was not uniformly cost-effective. In metabolic syndrome, only FIB-4 + TE was cost-effective. In obesity, all strategies were cost-effective. Given non-robustness in the estimated cost-effectiveness and the substantial budget impact, implementation should balance expected health gains against affordability.