Cost-utility analysis of glucagon-like peptide-1 receptor agonists for type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease in Thailand

Figure 1 Decision tree and Markov model. A: Decision tree; B: Markov model. In the decision tree, the square represents a decision node. The Markov model describes disease progression in metabolic dysfunction-associated steatotic liver disease. Arrows indicate possible patient transitions through the model. Solid arrows represent transition probabilities, whereas dashed arrows represent transitions to death states: Orange arrows indicate deaths from cardiovascular diseases, and black arrows indicate liver-related and other deaths. CVD: Cardiovascular disease; F: Fibrosis stage; HCC: Hepatocellular carcinoma; LR: Liver-related; MASLD: Metabolic dysfunction-associated steatotic liver disease; T2DM: Type 2 diabetes mellitus; Tp: Transition probability.

Figure 2 Tornado diagrams. A: Semaglutide compared with usual care; B: Liraglutide compared with usual care. The vertical axis lists the model parameters ordered by their magnitude of influence on the incremental cost-effectiveness ratio (ICER). The horizontal axis shows the ICER range as each parameter is varied between its minimum and maximum value. DC: Decompensated cirrhosis; DM: Diabetes mellitus; F: Fibrosis stage; ICER: Incremental cost-effectiveness ratio; MASLD: Metabolic dysfunction-associated steatotic liver disease; QALY: Quality-adjusted life year; THB: Thai baht; Tp: Transition probability.

Figure 3 Probabilistic sensitivity analyses. A: Cost-effectiveness plane showing incremental cost (THB) on the vertical axis against quality-adjusted life year (QALY) gained on the horizontal axis; B: Cost-effectiveness acceptability curve for semaglutide compared with usual care; C: Cost-effectiveness acceptability curve for liraglutide compared with usual care. In the cost-effectiveness acceptability curves, the vertical axis represents the probability of being cost-effective, and the horizontal axis shows willingness-to-pay (WTP) values. The dashed gray line represents the WTP threshold (THB/QALY gained). QALY: Quality-adjusted life year; THB: Thai baht; WTP: Willingness-to-pay.