Receptivity and susceptibility to care models for Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) in Europe: a mixed-methods, landscaping study.

BACKGROUND

The healthcare landscape for metabolic dysfunction-associated steatotic liver disease (MASLD) is evolving rapidly, and further introduction of care innovations is anticipated. We aimed to map current approaches to MASLD care and to gain health system insights supporting the implementation of novel, MASLD-related initiatives.

METHODS

We conducted a cross-sectional, mixed-methods comparative analysis, assessing receptivity and susceptibility to adopting new care models, defined as the extent to which a healthcare system can accommodate the implementation of an innovation. We distributed an in-depth survey amongst healthcare providers (May-October 2025), and performed document analyses.

RESULTS

A total of 36 health professionals from ten European countries were surveyed (36% primary care, 19% non-academic hospital, 39% university hospital), and 56 documents were analyzed. Alignment was observed across countries and care levels regarding standard practices of care. Patients still predominantly entered MASLD care upon incidental findings. Referral structures were largely absent, with MASLD rarely embedded in diabetes care. Accessibility and availability of care was suboptimal, relating to care organization, allocation of diagnostics, and reimbursement policies. MASLD guidelines were available in eight countries, but specific primary care guidance remained scarce. Available guidelines primarily differed in non-invasive tests utilization, follow-up, and pharmacotherapy recommendations.

CONCLUSION

The European healthcare landscape for MASLD is largely comparable across countries. Care for MASLD is not structurally embedded in national healthcare systems. All examined healthcare systems offered opportunities to strengthen receptivity and susceptibility to care innovations. Any MASLD-related innovations introduced in future must be tailored to local healthcare contexts to facilitate effective implementation.