Costs of two-step MASLD screening using ALT and elastography in children with overweight and obesity.

OBJECTIVES

Metabolic dysfunction-associated steatotic liver disease (MASLD) is prevalent among children with obesity. Although screening is widely performed in pediatric obesity-related comorbidity assessment, evidence on effectiveness and costs is lacking. This study quantifies costs of MASLD screening using ALT and vibration-controlled transient elastography (VCTE) in children with overweight and obesity.

METHODS

We prospectively analyzed costs of a two-step MASLD screening strategy in obesity clinics in the Amsterdam region. Children with overweight and obesity underwent ALT testing; those with elevated ALT were referred for further assessment according to MASLD guidelines. Healthcare and societal costs were calculated per child screened and per advanced MASLD case detected (VCTE ≥7.4 kPa). Scenario 1 included limited additional testing for other liver disorders and scenario 2 more elaborate testing.

RESULTS

In a screened population of 2376 children, healthcare costs were €144 per child screened and €5608 per advanced MASLD case detected; healthcare and societal costs combined were €201 per child screened and €7822 per case detected. Scenario 2 increased healthcare costs by 15%.

CONCLUSIONS

This study provides novel cost data on pediatric MASLD screening, which may inform policy and implementation strategies for children with overweight and obesity.