Economic modeling demonstrates that semaglutide 2.4mg (Wegovy) delivers healthcare value at €22,691 per quality-adjusted life year when treating 782,920 estimated Italian adults with metabolic dysfunction-associated steatohepatitis (MASH) and obesity. The 10-year Markov analysis found this cost falls below Italy's willingness-to-pay thresholds, with sensitivity analyses confirming robustness across variables. This economic validation arrives at a critical juncture as healthcare systems grapple with soaring GLP-1 drug costs amid unprecedented demand. The finding specifically targets MASH patients without diabetes—a population facing inevitable progression to cirrhosis, liver failure, and potential transplantation without intervention. What makes this analysis particularly relevant is its focus on preventing downstream liver complications rather than just weight loss, potentially justifying higher upfront pharmaceutical costs through avoided hospitalizations and procedures. However, the model's 10-year horizon may underestimate long-term liver benefits, while real-world adherence challenges could diminish projected outcomes. As European health authorities evaluate GLP-1 reimbursement policies, this Italian data provides crucial economic justification for covering these expensive medications in high-risk metabolic liver disease populations.