# Research Communication: Changing Aetiology of Chronic Liver Diseases in East Asia Pacific and HCC Surveillance in Non‐Cirrhotic Patients

## TL;DR

Chronic liver disease in East Asia Pacific is shifting toward metabolic causes, and HCC surveillance in non-cirrhotic patients is only cost-effective in certain groups.

## Contribution

The study identifies the changing aetiology of CLD and evaluates cost-effectiveness of HCC surveillance in non-cirrhotic patients in the EAP region.

## Key findings

- MASLD is projected to account for 80% of CLD prevalence in East Asia Pacific by 2040.
- HCC surveillance in non-cirrhotic patients is cost-effective only for chronic hepatitis B in selected older age groups.
- There is substantial variability in cost-effectiveness thresholds across countries in the region.

## Abstract

East Asia Pacific (EAP) faces a high burden of chronic liver disease (CLD), with metabolic dysfunction‐associated steatotic liver disease (MASLD) projected to account for about 80% of CLD prevalence by 2040. Using Global Burden of Disease 2021 data, we assessed CLD trends, transitions to hepatocellular carcinoma (HCC), and the cost‐effectiveness of non‐cirrhotic HCC surveillance. Despite declining viral hepatitis burden, MASLD and alcohol‐related CLD have risen. HCC surveillance in non‐cirrhotic patients was cost‐effective only for chronic hepatitis B in selected older age groups, with substantial variability across countries. These findings support refining surveillance guidelines and adaptation of risk stratification tools.

East Asia Pacific faces a rising CLD burden, with MASLD projected to account for 80% of CLD prevalence by 2040. HCC surveillance in non‐cirrhotic patients is cost‐effective only in select older age groups. Wide variation in thresholds across countries highlights the need for updated guidelines and risk‐based surveillance strategies.