Evaluating Long-Term Healthcare Resource Utilization in Biopsy-Confirmed MASLD: A Retrospective Longitudinal Observational Cohort Study in Sweden

OBJECTIVES: Limited evidence exists on factors contributing to long-term healthcare resource utilization (HCRU) in metabolic dysfunction-associated steatotic liver disease (MASLD). We assessed HCRU by disease severity, characterized patients with high HCRU and compared HCRU in disease progressors and non-progressors.

METHODS: Swedish adults with liver biopsy-confirmed MASLD from 1973–2020 were identified using medical records and followed up from index (first biopsy +30 days) until death or last database entry using medical charts and nationwide registries. A second biopsy ≥6 months after index was required for the progression analysis; progressors were those with worsening of liver fibrosis. Outcomes were adjusted mean annual numbers of hospitalizations and outpatient visits, and length of stay. Characteristics associated with high HCRU (numbers of hospitalizations and outpatient visits ≥80th percentile) were assessed in patients without liver cirrhosis at index. Negative-binomial regression models were adjusted by age, body mass index, type 2 diabetes (T2D), sex and calendar time.

RESULTS: Overall, 959 patients were included. Compared with early fibrosis (stage 0–1), liver cirrhosis was linked to more annual hospitalizations (adjusted mean [95% confidence interval] 0.89 [0.55–1.24] vs 0.37 [0.31–0.44]) and a longer length of stay (14.16 [6.93–21.38] vs 6.51 [5.46–7.56] days). A higher proportion of patients with high vs low HCRU were women (48.2% vs 33.1%) and had comorbidities, including T2D (31.4% vs 20.5%) and cardiovascular disease (11.4% vs 8.2%). Progressors had more outpatient visits (adjusted mean [95% CI] 8.22 [1.90–14.55] vs 4.59 [1.21–7.97]) and hospitalizations (0.19 [0.01–0.37] vs 0.17 [−0.04–0.38]) than non-progressors, but with largely overlapping confidence intervals due to the limited sample size (n=49).

CONCLUSIONS: More advanced liver disease, disease progression and comorbidities in patients without cirrhosis were linked to increased HCRU, supporting the need for holistic treatments addressing the disease itself and metabolic comorbidities in MASLD.