Cost-effectiveness of transient elastography for liver fibrosis screening in Thai patients with diabetes mellitus

Table 1 Input parameters

Input parameter	Distribution	Base-case value	SE	Ref.
Test performance1 (%)
FIB-4 index ≥ 1.3				Alkhouri et al[18]
Sensitivity	Beta	66.0	1.2
Specificity	Beta	65.0	1.4
SAFE score ≥ 0				Alkhouri et al[18]
Sensitivity	Beta	87.3	0.8
Specificity	Beta	35.1	1.4
TE, LSM ≥ 7 kPa				Selvaraj et al[10]
Sensitivity	Beta	80.1	2.1
Specificity	Beta	73.0	2.6
Epidemiological data
Prevalence of MASLD				Phisalprapa et al[12]
Age 18-39.9 years	Beta	0.353	0.013
Age 40-59.9 years	Beta	0.348	0.002
Age ≥ 60 years	Beta	0.244	0.004
Prevalence of MASLD with significant fibrosis				Primary data (Supplementary Table 2)
Age 30-39.9 years	Beta	0.304	0.096
Age 40-49.9 years	Beta	0.333	0.068
Age 50-59.9 years	Beta	0.304	0.037
Age 60-69.9 years	Beta	0.404	0.031
Age 70-79.9 years	Beta	0.403	0.041
Age ≥ 80 years	Beta	0.659	0.074
Incidence of MASLD (cases per 1000 patient-years)	Beta	42.8	2.2	Park et al[21]
Treatment effectiveness
RRR of lifestyle modification	Log-normal	0.204	0.124	Vilar-Gomez et al[8]
Transitional probability
No MASLD - MASLDF0	Beta	0.043	0.002	Park et al[21]
MASLDF0 - no MASLD	Beta	0.024	0.013	Le et al[22]
MASLDF0 - MASLDF1	Beta	0.063	0.025
MASLDF1 - MASLDF0	Beta	0.025	0.017
MASLDF1 - MASLDF2	Beta	0.067	0.025
MASLDF2 - MASLDF1	Beta	0.045	0.022
MASLDF2 - MASLDF3	Beta	0.056	0.024
MASLDF3 - MASLDF2	Beta	0.058	0.024
MASLDF3 - MASLDF4/CC	Beta	0.044	0.021
MASLDF4/CC - MASLDF3	Beta	0.046	0.022
MASLDF4/CC - DC	Beta	0.043	0.041	Gruneau et al[23]
MASLDF4/CC - HCC	Beta	0.008	0.017
DC - HCC	Beta	0.029	0.045
DC - LT (age ≤ 70 years)	Beta	0.003	0.012
HCC - LT (age ≤ 70 years)	Beta	0.012	0.027
Utilities
DM	Beta	0.753	0.116	Deerochanawong et al[32]
MASLDF0-F3	Beta	0.753	0.116
MASLDF4/CC	Beta	0.748	0.042	Chongmelaxme et al[19]
DC	Beta	0.603	0.022	Prakongsai et al[24]
HCC	Beta	0.380	0.015	Levy et al[33]
LT	Beta	0.570	0.015
Post LT	Beta	0.683	0.015	Prakongsai et al[24]
Costs
Direct medical costs, 2023; THB (USD)
FIB-4 index	Gamma	271.0 (7.8)	NA2	Riewpaiboon[34]
SAFE score	Gamma	355.4 (10.3)	NA2
Transient elastography	Gamma	2000.0 (57.7)	500.0 (14.4)	Primary data
Lifestyle modification program	Gamma	1426.8 (41.2)	356.7 (10.3)	Riewpaiboon[34]
Treatment, THB (USD) per year
DM without MASLD	Gamma	9579.6 (276.6)	2394.9 (69.1)	Primary data (Supplementary Table 4)
DM with MASLDF0-F3	Gamma	12340.9 (356.3)	3085.2 (89.1)	Primary data (Supplementary Table 4)
DM with MASLDF4/CC	Gamma	38746.5 (1118.6)	9686.6 (279.6)	Primary data (Supplementary Table 4)
DC	Gamma	151164.1 (4363.9)	37791.0 (1091.0)	Chongmelaxme et al[19] and Thongsawat et al[35]
HCC	Gamma	184822.2 (5335.6)	46205.5 (1333.9)
LT	Gamma	683432.3 (19729.9)	170858.1 (4932.5)
Post LT	Gamma	110287.1 (3183.9)	27571.8 (796.0)
Direct non-medical costs, THB (USD) per visit
Secondary hospital
Food	Gamma	33.1 (1.0)	4.0 (0.1)	Riewpaiboon[34]
Transportation	Gamma	91.2 (2.6)	5.2 (0.1)
Tertiary hospital
Food	Gamma	66.2 (1.9)	6.7 (0.2)	Riewpaiboon[34]
Transportation	Gamma	179.7 (5.2)	14.6 (0.4)

¹The sensitivity and specificity of the tests were compared to liver biopsy, a reference standard for liver fibrosis diagnosis.

²The values were not presented because the sensitivity analyses were performed using standard errors of the unit costs. The unit costs ± standard errors of aspartate aminotransferase, alanine aminotransferase, and globulin were 84.4 ± 21.1 Thai baht (THB, 2.4 ± 0.6 United States dollars [USD]), while the unit cost of platelet count was 102.1 ± 25.5 THB (2.9 ± 0.7 USD).

CC: Compensated cirrhosis; DC: Decompensated cirrhosis; DM: Diabetes mellitus; F: Fibrosis stage; FIB-4: Fibrosis-4 index; HCC: Hepatocellular carcinoma; LSM: Liver stiffness measurement; LT: Liver transplantation; MASLD: Metabolic dysfunction-associated steatotic liver disease; RRR: Relative risk reduction; NA: Not applicable; SAFE: Steatosis-associated fibrosis estimator score; THB: Thai baht; USD: United States dollars.