Agirre‐Garrido, Leire

Abstract Background & Aims: Alcohol is a leading global risk factor, over 200 diseases and injuries, but policy adoption varies. We updated the Alcohol Preparedness Index (API) to track global and regional policy trends from 2010–2019. Methods: Using WHO GISAH data for 141 countries, we scored five domains (policy frameworks; production/pricing/taxation; marketing/availability; drink-driving; monitoring/surveillance). The primary endpoint was % change in API. Trends were summarized by WHO region and correlates tested in adjusted regression. Results: In 2019, <25% of countries had a strong national alcohol plan and 40% had none. Production/pricing/taxation increased most (27%→78%); monitoring/surveillance reached strong levels in 47.5%. Median API increased from 57.0 [39.0–82.0] (2010) to 74.8 [58.3–83.5] (2016) and stayed above baseline in 2019 (67.8 [51.2–83.8]). Larger population predicted less API gain (β=−19.1, p<0.05); HDI and per-capita consumption did not. Conclusions: Global alcohol policy preparedness increased from 2010–2019.

Importance Metabolic dysfunction–associated steatohepatitis (MASH) represents a high, underprioritized burden among noncommunicable diseases (NCDs) and people living with type 2 diabetes (T2D). Objective To identify cost-effective management approaches to prevent, detect, and treat MASH and liver fibrosis in people living with T2D. Design, Setting, and Participants This economic evaluation consisted of a generalized cost-effectiveness analysis (GCEA) that was conducted for 12 countries (Brazil, Chile, Germany, Italy, Japan, Saudi Arabia, South Africa, Spain, Sweden, Tanzania, Thailand, and the United States), across all 6 World Health Organization (WHO) regions. A cohort state-transition model simulated liver disease development and its impact on a synthetic cohort, aged 19 years and older and living with T2D, over their lifespan across 10 liver health states. Exposures Using an 80% coverage level, 14 management approaches were compared, including screening via the Fibrosis-4 (FIB-4) test and Enhanced Liver Fibrosis (ELF) test or vibration-controlled transient elastography (VCTE) as well as treatment with pharmacological and nonpharmacological interventions. Main Outcomes and Measures The main outcomes were the average cost-effectiveness ratios (ACERs) and the incremental cost-effectiveness ratios (ICERs), which were used to construct care expansion paths by ranking the management approaches in order of cost-effectiveness. The main measures were the total incremental costs and the total incremental quality-adjusted life-years (QALYs) of each intervention. Results In this GCEA, the outcomes were evaluated with respect to country-specific willingness-to-pay thresholds. The standard of care had the lowest ACERs in 8 countries (not in Chile, Germany, Saudi Arabia, or the United States). Treatment with intensive lifestyle interventions (ILIs), after screening via ELF or VCTE, was cost-effective in all countries. ILIs and treatment with semaglutide was cost-effective in 11 countries (not in Tanzania); ILIs and treatment with resmetirom was cost-effective in 8 countries (not in Brazil, South Africa, Tanzania, or Thailand). Conclusion and Relevance In this economic evaluation, screening followed by ILIs was found to be a cost-effective management approach for MASH and liver fibrosis among people living with T2D in all countries. Screening followed by pharmacological treatment was cost-effective in most countries. These results can inform health policy decision-making and further the development of WHO recommended interventions to address NCDs.