MAFLD Pathway for Australian GPs: RACGP Context & GESA 2023 Alignment
A practical summary of who to screen, how to use FIB-4, and when liver elastography closes the indeterminate gap — aligned with GESA's MAFLD clinical care pathway used in Australian practice.
Australian GPs manage the largest volume of metabolic liver disease in the country. RACGP chronic disease frameworks emphasise cardiovascular and diabetes risk — MAFLD sits at the intersection. GESA published an updated MAFLD clinical care pathway in 2023 that gives primary care a clear sequence: identify at-risk patients → calculate FIB-4 → use elastography when FIB-4 is indeterminate or when staging is needed for management decisions.
Step 1 — Who to assess
Prioritise patients with:
- Type 2 diabetes (MAFLD prevalence 50–75% in many cohorts)
- BMI ≥30 or metabolic syndrome
- Persistent ALT elevation on repeat testing
- Known MAFLD on imaging with unclear fibrosis stage
Step 2 — FIB-4 first
FIB-4 uses age, AST, ALT, and platelet count. It is near-zero marginal cost and performs well as a rule-out test. Use the FIB-4 calculator in clinic. Remember age skews FIB-4 upward — consider adjusted thresholds in patients over 65.
| FIB-4 | Interpretation | Typical action |
|---|---|---|
| < 1.3 | Low risk | Lifestyle + repeat FIB-4 in 1–2 years |
| 1.3 – 2.67 | Indeterminate | Elastography recommended |
| > 2.67 | High risk | Refer or elastography + specialist review |
Step 3 — Elastography when FIB-4 is indeterminate
GESA recommends liver stiffness measurement (LSM) for patients in the grey zone. Community-based guided elastography allows same-visit staging without a hospital FibroScan queue. For MAFLD, LSM <8 kPa generally supports ongoing primary care; ≥12 kPa warrants hepatology referral.
MSAC 1797 — what GPs should know
MSAC did not fund standalone FibroScan on the MBS for MASLD screening (Application 1797, early 2025). That affects how private FibroScan clinics bill — not whether elastography is clinically useful. Some integrated ultrasound pathways attract partial MBS contribution when criteria are met. See MBS rebate update and MSAC 1797 analysis.
For a longer screening guide, see MAFLD screening Australia (clinical guide).
GP FAQ
What FIB-4 score is low risk in MAFLD?
For patients under 65, FIB-4 below 1.3 is generally low risk for advanced fibrosis. Above 2.67 is high risk and warrants referral or further investigation. Between 1.3 and 2.67 is indeterminate — elastography is the recommended second-line test per GESA MAFLD guidance.
Does RACGP recommend elastography for fatty liver?
RACGP and GESA-aligned pathways support non-invasive staging in primary care when blood-based scores are indeterminate or when metabolic risk is high. Elastography is not a population screening test for all Australians — it is used in risk-selected patients after FIB-4 or when clinical suspicion is elevated.
What kPa threshold matters after an indeterminate FIB-4?
For MAFLD/MASLD, liver stiffness below ~8 kPa generally supports primary care management; 8–12 kPa is intermediate; above 12 kPa warrants hepatology input. Disease-specific thresholds differ for HBV and HCV.