Photo Credit: Jelina Preethi
MASH’s economic burden is substantial, particularly for patients with MASH and multiple comorbidities, even in the absence of cirrhosis.
Metabolic dysfunction associated steatohepatitis (MASH), previously known as nonalcoholic steatohepatitis (NASH), is a severe and progressive form of liver disease. MASH is particularly concerning as it can progress to irreversible cirrhosis and lead to liver related complications such as end stage liver disease and hepatocellular carcinoma. Furthermore, MASH is strongly associated with common metabolic comorbidities, including cardiovascular disease (CVD), obesity, and type 2 diabetes.
The economic burden associated with MASH is substantial, and the disease is underdiagnosed in many patients. It is estimated that about 5% of the US population has MASH, yet it often remains undetected until complications arise. Diagnosis relies on liver biopsy, an invasive procedure that can delay diagnosis and increase healthcare costs. Understanding the economic impact of MASH is crucial, given its rising prevalence and associated comorbidities.
Recent research has highlighted the significant costs associated with MASH, particularly in the United States and Europe. For instance, a study estimated that lifetime costs for all US patients with MASH in 2017 reached $222.6 billion, with advanced MASH accounting for $95.4 billion. In Europe, the economic burden is estimated to be between €8.5 billion and €19.5 billion. These figures underline the urgent need for better diagnostic and management strategies to mitigate these costs.
Unmet Needs in Understanding MASH’s Economic Burden
Despite the growing recognition of MASH’s financial impact, there remains a significant gap in understanding how the severity of MASH (including the presence or absence of cirrhosis) and associated comorbidities influence healthcare costs.
Studies suggest that patients with MASLD (which includes those with less advanced disease) incur the greatest absolute costs, mainly because they represent a larger patient population than those with more advanced MASH. Additionally, the presence of comorbidities such as type 2 diabetes and CVD may further exacerbate the economic burden, yet the precise impact of these comorbidities, especially in patients without cirrhosis, remains underexplored.
A recent retrospective observational study published in Hepatology Communications aimed to address these gaps by analyzing anonymized data from a large US healthcare dataset. The study included adult patients diagnosed with MASH between October 2015 and June 2023. Patients were categorized into two groups: those with cirrhosis and those without. The study examined baseline demographics, clinical characteristics, comorbidities, and healthcare costs before and after MASH diagnosis.
Zobair M. Younossi, MD, and colleagues focused on understanding the annualized healthcare costs associated with MASH, particularly the factors contributing to high cost burdens. This included investigating how comorbidities such as CVD and type 2 diabetes influenced healthcare utilization and costs in both cirrhotic and non cirrhotic patients.
The study included 16,919 patients, of whom 88% did not have cirrhosis at the time of MASH diagnosis. Patients in the cirrhosis group had significantly higher healthcare costs compared to those without cirrhosis, with annualized follow-up costs more than doubling in the cirrhosis group. The presence of comorbidities such as hypertension, hyperlipidemia, and type 2 diabetes was higher in the cirrhosis group, contributing to the increased costs.
Notably, even in the absence of cirrhosis, patients with MASH incurred substantial healthcare costs, particularly those with multiple comorbidities. The study found that the presence of chronic conditions like CVD and chronic kidney disease significantly increased healthcare costs, emphasizing the need for integrated care approaches that address both liver disease and its associated comorbidities.
Implications for Healthcare Management
The findings underscore the need for early identification and management of MASH, especially in patients with comorbidities that exacerbate the economic burden. As MASH remains asymptomatic until advanced stages, proactive screening and non-invasive diagnostic methods could play a crucial role in reducing healthcare costs by enabling earlier intervention.
Moreover, the study highlights the importance of developing targeted treatment strategies that address MASH and its associated comorbidities. This approach could help mitigate the financial impact on healthcare systems while improving patient outcomes.
In conclusion, the study provides valuable insights into the economic burden of MASH, particularly in patients without cirrhosis. By understanding the factors that drive healthcare costs, stakeholders can develop more effective strategies to manage this growing public health concern.
