Enhanced liver fibrosis test improves diagnostic efficiency and reduces testing costs for advanced liver fibrosis in steatotic liver disease.

We performed cost-analysis to evaluate the most economic testing approach for diagnosing compensated advanced chronic liver disease in low- and high-prevalence populations in the Finnish healthcare system. In a simulated analysis of 1000 individuals at risk of (low prevalence) or diagnosed (high prevalence) with metabolic dysfunction-associated steatotic liver disease or alcohol-related liver disease, we compared five different testing strategies for compensated advanced chronic liver disease based on costs and incremental diagnostic accuracy, The Fibrosis-4 index, enhanced liver fibrosis test, and liver stiffness measurements were performed in various combinations. In the low-prevalence setting, the least costly testing strategy for compensated advanced chronic liver disease detection was fibrosis-4 index, followed by enhanced liver fibrosis test if fibrosis-4 index > 1.30, and liver stiffness measurement if the enhanced liver fibrosis test score was > 9.8. In the high-prevalence setting, the most economic testing strategy was fibrosis-4 index, followed by enhanced liver fibrosis test if fibrosis-4 index was 1.30-2.67, and/or liver stiffness measurement if fibrosis-4 index > 2.67 or enhanced liver fibrosis test score > 9.8. Integration of the enhanced liver fibrosis test in the diagnostic testing strategy for compensated advanced chronic liver disease in individuals with risk factors for or a diagnosis of metabolic dysfunction-associated steatotic/alcohol-related liver disease can decrease costs by reducing unnecessary referrals to secondary care and limiting the need for liver stiffness measurements, while maintaining good diagnostic accuracy.