ArticleDigestive diseases and sciences2026
Cost-Effectiveness of AI-Enabled Electrocardiography for Screening MASLD-Associated Advanced Chronic Liver Disease in the US Population.
Article in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMASLD is the most prevalent chronic liver disease worldwide, with pooled global prevalence estimates of approximately 30%. Current noninvasive pathways have improved risk stratification, but they depend on stepwise testing and follow-through in routine care. Against this background, artificial intelligence-enabled electrocardiography (AI-ECG) has emerged as a potentially scalable, opportunistic tool that could use an already familiar test to identify patients who may benefit from liver-specific assessment.
methodsA decision-analytic Markov model was developed using TreeAge Pro Healthcare 2026 to evaluate screening strategies for MASLD-associated ACLD/cirrhosis in the U.S. POPULATION: Four strategies were compared: AI-ECG + TE, FIB-4 + TE, sequential AI-ECG + FIB-4 + TE, and no systematic screening. The model used annual cycles over 5-year and 10-year horizons. Analyses were conducted from the payer perspective. Costs and outcomes were accrued annually and discounted at 3% per year.
resultsAcross all modeled scenarios, screening increased total costs and QALYs compared with no systematic screening over both 5-year and 10-year horizons. In the MASLD base case at 5 years, AI-ECG + TE had an ICER of $11,655 per QALY, while FIB-4 + TE and sequential AI-ECG + FIB-4 + TE had ICERs of $11,835 and $12,251 per QALY, respectively. At 10 years, AI-ECG + TE had an ICER of $10,615 per QALY, FIB-4 + TE had an ICER of $10,480 per QALY, and sequential AI-ECG + FIB-4 + TE had an ICER of $10,833 per QALY. Similar patterns were observed in the MASLD-T2D and MASLD-obesity scenarios.
conclusionAI-ECG + TE demonstrated cost-effectiveness broadly comparable to FIB-4 + TE across modeled scenarios, without clear economic dominance. AI-ECG is best framed as a potential complementary first-step pathway for MASLD-associated ACLD/cirrhosis screening, rather than as a replacement for established noninvasive fibrosis algorithms.
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