REAL-WORLD IMPACT OF MODERN OBESITY PHARMACOTHERAPY ON LIVER OUTCOMES IN MEDICARE-ENHANCED LAB AND DEMOGRAPHICS DATA: 2021-2025
Author(s)
Onur Baser, MA, MS, PhD1, Katarzyna Rodchenko, MA, MPH2, Nehir Yapar, BS2, Xianxin Zhu, MS2, Lixuan Wu, MS2;
1City University of New York (CUNY), Graduate School of Public Health, New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA
1City University of New York (CUNY), Graduate School of Public Health, New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA
OBJECTIVES: Obesity-related metabolic dysfunction-associated steatotic liver disease (MASLD)/metabolic dysfunction-associated steatohepatitis (MASH) is common in older adults, driving progression to cirrhosis and liver-related hospitalization. The impact of modern anti-obesity pharmacotherapy on liver tests and liver-related outcomes among Medicare fee-for-service (FFS) beneficiaries diagnosed with obesity and MASLD/MASH was examined.
METHODS: Medicare-Enhanced Lab & Demographics (MELDTM; 100% CMS Medicare FFS claims deterministically linked to laboratory results and EMR) dataset was used to create a retrospective cohort of beneficiaries aged ≥65 years with obesity (BMI≥30kg/m²) and MASLD/MASH diagnosis 2021-2025. Data captured serial Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Gamma-Glutamyl Transferase (GGT), platelets, calculated Fibrosis (FIB)‑4, and liver imaging when available. Liver test results changes and incidence of cirrhosis and liver-related hospitalization were evaluated over ≈30 months using weighted regression and time‑to‑event models.
RESULTS: Among 260,000 eligible beneficiaries, 82,000 initiated glucagon-like peptide-1 (GLP‑1)/dual GIP/GLP‑1 agent (treatment); 178,000 received no obesity pharmacotherapy (non‑treatment). Baseline mean BMI was ~37kg/m²; mean ALT:52 vs 49U/L; FIB‑4:2.1 vs 2.2 in both groups. Adjusted mean ALT decreased by 18U/L (−35%) with treatment vs 7U/L (−14%) without (difference −11U/L; p<0.001), and AST by 12 vs 4U/L (difference −8U/L; p<0.001). FIB‑4 declined by 0.4 (−19%) in treated vs 0.1 (−5%) non‑treated patients (difference −0.3; p<0.001); ≥30% FIB‑4 reduction in 41% vs 22% of patients. Incident cirrhosis occurred in 4.2% of treated vs 6.8% of non‑treated beneficiaries (adjusted hazard ratio [aHR]:0.68; 95%CI:0.62-0.75), and liver-related hospitalization in 7.9% vs 11.5% (aHR:0.72; 95%CI:0.67-0.78).
CONCLUSIONS: In this large cohort of beneficiaries diagnosed with obesity and MASLD/MASH, linked 100% Medicare claims and EMR enabled robust liver-focused real‑world evidence. Incretin‑based obesity pharmacotherapy was associated with substantially greater improvements in liver enzymes and non‑invasive fibrosis indices and ~30% lower risks of cirrhosis and liver‑related hospitalization vs non‑treatment, supporting the benefit of these agents for liver and metabolic outcomes in routine practice.
METHODS: Medicare-Enhanced Lab & Demographics (MELDTM; 100% CMS Medicare FFS claims deterministically linked to laboratory results and EMR) dataset was used to create a retrospective cohort of beneficiaries aged ≥65 years with obesity (BMI≥30kg/m²) and MASLD/MASH diagnosis 2021-2025. Data captured serial Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Gamma-Glutamyl Transferase (GGT), platelets, calculated Fibrosis (FIB)‑4, and liver imaging when available. Liver test results changes and incidence of cirrhosis and liver-related hospitalization were evaluated over ≈30 months using weighted regression and time‑to‑event models.
RESULTS: Among 260,000 eligible beneficiaries, 82,000 initiated glucagon-like peptide-1 (GLP‑1)/dual GIP/GLP‑1 agent (treatment); 178,000 received no obesity pharmacotherapy (non‑treatment). Baseline mean BMI was ~37kg/m²; mean ALT:52 vs 49U/L; FIB‑4:2.1 vs 2.2 in both groups. Adjusted mean ALT decreased by 18U/L (−35%) with treatment vs 7U/L (−14%) without (difference −11U/L; p<0.001), and AST by 12 vs 4U/L (difference −8U/L; p<0.001). FIB‑4 declined by 0.4 (−19%) in treated vs 0.1 (−5%) non‑treated patients (difference −0.3; p<0.001); ≥30% FIB‑4 reduction in 41% vs 22% of patients. Incident cirrhosis occurred in 4.2% of treated vs 6.8% of non‑treated beneficiaries (adjusted hazard ratio [aHR]:0.68; 95%CI:0.62-0.75), and liver-related hospitalization in 7.9% vs 11.5% (aHR:0.72; 95%CI:0.67-0.78).
CONCLUSIONS: In this large cohort of beneficiaries diagnosed with obesity and MASLD/MASH, linked 100% Medicare claims and EMR enabled robust liver-focused real‑world evidence. Incretin‑based obesity pharmacotherapy was associated with substantially greater improvements in liver enzymes and non‑invasive fibrosis indices and ~30% lower risks of cirrhosis and liver‑related hospitalization vs non‑treatment, supporting the benefit of these agents for liver and metabolic outcomes in routine practice.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO88
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)