RWD312 CHANGING ETIOLOGY OF CIRRHOSIS AND OTHER CHRONIC LIVER DISEASES: IMPLICATIONS FOR HEPATOCELLULAR CARCINOMA SURVEILLANCE IN NON-CIRRHOTIC PATIENTS

Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol use are the fastest-growing causes of cirrhosis and other chronic liver diseases (CLD), challenging hepatocellular carcinoma (HCC) surveillance. Many HCC cases occur in non-cirrhotic patients, yet a consensus on surveillance for this group is lacking. This study evaluates the evolving etiology of CLD and the cost-effectiveness of HCC surveillance in non-cirrhotic patients. Methods: We analyzed data from the Global Burden of Disease Study 2021 to assess CLD-related disability adjusted life years (DALYs) and annual transition rates to liver cancer from 1990 to 2021, with projections to 2040 using a Bayesian age-period-cohort model. Trends in age-standardized DALY rates (ASDR) were evaluated using estimated annual percentage change (EAPC). The cost-effectiveness of HCC surveillance in non-cirrhotic patients was assessed across 195 countries under reference, better, and worse scenarios, compared with surveillance guidelines from four regional and 30 national recommendations. Results: Globally, ASDR declined (EAPC: -1.07% [95% CI: -1.37% to -1.16%]) across all etiologies except MASLD, which remained stable but is projected to account for 81.53% of CLD prevalence by 2040. While hepatitis B and C remained the leading causes of CLD DALYs, the burden from alcohol use and MASLD increased across sexes and socio-demographic index (SDI) regions. Despite ASDR declines, total DALYs increased by 27.93% due to population growth and aging. The transition from CLD to liver cancer also increased, particularly higher in East Asia Pacific, South Asia, and high-SDI regions. Under the reference scenario, HCC surveillance was cost-effective in 26.15% of countries for hepatitis B and 2.56% for hepatitis C, but not for MASLD, with thresholds for initiating surveillance varying significantly by country. Conclusions: The rising burden of MASLD and alcohol related CLD underscores the need for tailored public health strategies. HCC surveillance in non-cirrhotic patients may not be broadly cost-effective, necessitating updated guidelines and validated risk stratification tools.