by Wei Yoon Poh, Amirah Azzeri, Shamsul Mohd Zain, Rosmawati Mohamed, Kim Sui Wan, Xe Hui Lee, Maznah Dahlui, Fatiha Hana Shabaruddin Background and aim Most international guidelines recommend a two-step approach using the Fibrosis-4 index (FIB-4) and vibration-controlled transient elastography (VCTE) to identify advanced fibrosis, a key predictor of all-cause and liver-related mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). However, VCTE is not available in most primary care settings in Malaysia, and there is scarce data on the cost-effectiveness of different approaches.
This study evaluated the cost-effectiveness of three referral pathways for identifying advanced fibrosis among type 2 diabetes mellitus(T2DM) patients with MASLD. Methods We developed a decision-analytical model from the healthcare provider’s perspective, using 1,000 simulated patients to compare: (i) Current Practice (direct referral based on elevated alanine transaminase), (ii) Clinical Practice Guidelines (CPG) Pathway using FIB-4 single-cutoff 1.3, and (iii) FIB-4 dual-cutoffs (1.3,3.25) followed by a gamma-glutamyl transferase (GGT) test for indeterminate cases (Sequential FIB-4/GGT Pathway).
Current practice served as the reference comparator.
PLOS ONE (Medicine) published a clinical update in Research Highlights on 28 May 2026.
The item focuses on Cost-effectiveness of various referral pathways to identify advanced fibrosis among type 2 diabetes mellitus patients with metabolic dysfunction-associated steatotic liver disease in primary care setting in Malaysia.
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