Researchers observed the use of a discrete event simulation using non-invasive tests for patients with nonalcoholic steatohepatitis.
The diagnostic pathways of metabolic dysfunction-associated steatohepatitis (MASH) can be more successfully understood with the introduction of discrete event simulation (DES) using non-invasive tests (NITs), according to a poster presented at the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition.1
“MASH, previously referred to as nonalcoholic steatohepatitis, is a leading cause of liver-related morbidity, mortality, and high costs. Early and accurate identification of patients with non-cirrhotic MASH may decrease long-term resource utilization and cost,” wrote authors of the poster.
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According to American Liver Foundation statistics, MASH is growing increasingly prevalent in the US. There are currently around 9 to 15 million US adults with MASH, accounting for up to 6.5% of the population. Furthermore, these rates are expected to rise by 63% come the year 2030.2
With the disease burden of MASH impacting a large group of US adults, health care experts are looking to alleviate the high health care costs that have accompanied the increase in MASH cases across the country. Using the DES model, researchers aimed to establish a standard of care and service that models the capabilities of currently accepted screening strategies.
There are currently around 9 to 15 million adults in the US living with MASH. | image credit: valiantsin / stock.adobe.com
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“A DES model was built comparing the use of various [NITs] and combinations of sequential NITs to identify patients with MASH and advanced fibrosis. The entire care pathway was considered including screening, disease progression, outpatient and inpatient care, and cost data over a 3-year time horizon,” they continued.1
The DES was designed for study participants to move through the model, capturing the utilization and costs of health care, as well as yearly disease progression, for participants with MASH. Researchers then simulated the diagnosis of MASH in 5 separate screening scenarios (SS): enhanced liver fibrosis (ELF) alone; magnetic resonance elastography (MRE) alone; transient elastography (TE) alone; ELF followed by TE; and ELF followed by MRE.
The DES model included a total of 100,000 participants with at-risk MASH. For the ELF SS, 86% of patients were successfully diagnosed, while 26% of cirrhotic patients were identified correctly. For the MRE-only SS, 82% were successfully diagnosed and 66% of cirrhotic patients were identified correctly. For the TE-only SS, 68% were successfully diagnosed and 42% of cirrhotic patients were identified correctly.
Finally, for the 2 scenarios using screening methods in conjunction with ELF, 92% of patients were correctly diagnosed when TE followed ELF, and 93% of patients were correctly diagnosed when MRE followed ELF.
After testing multiple screening strategies for the diagnosis of MASH, researchers agree that a DES model using NITs can advance the industry’s current knowledge regarding how to quickly and effectively diagnose this specific type of liver disease. While the success and effectiveness of screening for MASH diagnosis were researchers’ top priority in the study, they believe further advancements in DES models will lead to an even faster and more accurate diagnosis going forward.
“This DES model effectively simulated MASH diagnostic pathways using NITs,” concluded authors of the poster.1 “Improvements in screening will result in early and accurate diagnosis. Future simulation will include modeling inpatient and outpatient outcomes and associated resources and costs based on accuracy of screening.”
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