BURDEN OF MASLD IN INDIA: A SYSTEMATIC REVIEW OF EPIDEMIOLOGIC AND ECONOMIC EVIDENCE TO INFORM HTA
Author(s)
Rajanikanth Manupati, M.Pharm1, Amit Kumar, BSc1, Mahendra Kumar Rai, PhD2.
1Trinity Life Sciences, Gurgaon, India, 2Trinity Lifesciences, Singapore, Singapore.
1Trinity Life Sciences, Gurgaon, India, 2Trinity Lifesciences, Singapore, Singapore.
OBJECTIVES: Metabolic dysfunction-associated steatotic liver disease (MASLD) is rapidly emerging as a leading cause of chronic liver disease globally. In India, escalating metabolic risk factors driven by urbanisation and lifestyle change are expected to amplify the disease burden. This study systematically reviewed epidemiologic, clinical, and economic evidence to quantify disease burden and identify evidence gaps in India relevant to health technology assessment (HTA).
METHODS: A systematic literature review was conducted in PubMed, Embase, and Google Scholar for studies published between January 2010 and May 2026 in accordance with PRISMA 2020 guidelines. Search terms included MASLD/NAFLD, India, prevalence, burden, and cost. Two reviewers independently screened studies and extracted data. Study quality was assessed using standard risk-of-bias frameworks. Evidence was synthesised descriptively due to heterogeneity in study populations and designs
RESULTS: Of 1,019 identified records, 23 studies were included. MASLD prevalence in India was high and heterogeneous, ranging from 28.1% in average-risk populations to 52.8% in high-risk groups, with higher estimates reported in hospital-based versus community settings (40.8% vs 28.2%). Urban populations exhibited particularly high prevalence (53.7%-61.5%). MASLD was strongly associated with obesity, type 2 diabetes, and metabolic syndrome, with progression to advanced fibrosis, cirrhosis, and hepatocellular carcinoma. NASH-related cirrhosis accounted for approximately 20% of liver transplants in India in 2022. Economic evidence was limited; one micro-costing study reported substantial financial burden, including ICU costs of INR 163,664, out-of-pocket expenditure of INR 142,297 per patient.
CONCLUSIONS: MASLD imposes a substantial and growing clinical and economic burden in India. However, HTA is constrained by limited nationally representative data and sparse cost evidence. Strengthening real-world evidence on disease progression, costs, and long-term outcomes is critical to inform cost-effective screening, risk stratification, and treatment strategies in Indian healthcare settings.
METHODS: A systematic literature review was conducted in PubMed, Embase, and Google Scholar for studies published between January 2010 and May 2026 in accordance with PRISMA 2020 guidelines. Search terms included MASLD/NAFLD, India, prevalence, burden, and cost. Two reviewers independently screened studies and extracted data. Study quality was assessed using standard risk-of-bias frameworks. Evidence was synthesised descriptively due to heterogeneity in study populations and designs
RESULTS: Of 1,019 identified records, 23 studies were included. MASLD prevalence in India was high and heterogeneous, ranging from 28.1% in average-risk populations to 52.8% in high-risk groups, with higher estimates reported in hospital-based versus community settings (40.8% vs 28.2%). Urban populations exhibited particularly high prevalence (53.7%-61.5%). MASLD was strongly associated with obesity, type 2 diabetes, and metabolic syndrome, with progression to advanced fibrosis, cirrhosis, and hepatocellular carcinoma. NASH-related cirrhosis accounted for approximately 20% of liver transplants in India in 2022. Economic evidence was limited; one micro-costing study reported substantial financial burden, including ICU costs of INR 163,664, out-of-pocket expenditure of INR 142,297 per patient.
CONCLUSIONS: MASLD imposes a substantial and growing clinical and economic burden in India. However, HTA is constrained by limited nationally representative data and sparse cost evidence. Strengthening real-world evidence on disease progression, costs, and long-term outcomes is critical to inform cost-effective screening, risk stratification, and treatment strategies in Indian healthcare settings.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
HTA37
Topic
Health Technology Assessment
Topic Subcategory
Systems & Structure, Value Frameworks & Dossier Format
Disease
SDC: Geriatrics, SDC: Infectious Disease (non-vaccine), SDC: Rare & Orphan Diseases, SDC: Urinary/Kidney Disorders