Global Economic Burden of Metabolic Dysfunction-Associated Steatohepatitis With Cirrhosis: A Systematic Literature Review
Author(s)
Jeffrey Lazarus, PhD1, Hannes Hagström, PhD2, Chris Hellmund, PhD3, Mazen Noureddin, PhD4, Riku Ota, MBA, MSPH5, Mary Rinella, PhD6, Giada Sebastiani, PhD7, Fotis Tefos, MSc8, Tobias Weitzel, MSc8, Zobair M. Younossi, MD., MPH9.
1Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain, 2Karolinska Institutet, Stockholm, Sweden, 3Oxford PharmaGenesis, Oxford, United Kingdom, 4Houston Methodisr, Houston, TX, USA, 5Global Payer Evidence Lead, Novo Nordisk, Søborg, Denmark, 6The University of Chicago, Chicago, IL, USA, 7McGill University, Montreal, QC, Canada, 8Novo Nordisk A/S, Søborg, Denmark, 9The Global NASH/MASH Council, Washington, DC, USA.
1Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain, 2Karolinska Institutet, Stockholm, Sweden, 3Oxford PharmaGenesis, Oxford, United Kingdom, 4Houston Methodisr, Houston, TX, USA, 5Global Payer Evidence Lead, Novo Nordisk, Søborg, Denmark, 6The University of Chicago, Chicago, IL, USA, 7McGill University, Montreal, QC, Canada, 8Novo Nordisk A/S, Søborg, Denmark, 9The Global NASH/MASH Council, Washington, DC, USA.
OBJECTIVES: Metabolic dysfunction-associated steatohepatitis (MASH) is the progressive form of metabolic dysfunction-associated steatotic liver disease, the most common chronic liver disease. The most severe MASH stage is characterized by cirrhosis, which has a considerable impact on healthcare systems. Here, we report data on the economic burden of MASH with cirrhosis.
METHODS: In this systematic literature review (SLR), Embase, MEDLINE and the Cochrane Library were searched for clinical trials, observational studies and SLRs/meta-analyses reporting relevant outcomes in patients with cirrhosis due to MASH, published 1 January 2014-25 July 2024.
RESULTS: Of 3397 studies screened, 317 met the inclusion criteria. Out of 35 studies reporting economic outcomes (total patients with cirrhosis: approximately N=820,000), 29 were from USA and/or Europe. Cirrhosis was associated with elevated costs. In two studies (patients with cirrhosis: n=70,522), annual healthcare costs were 1.3-2.7 times greater in MASH with cirrhosis than MASH without cirrhosis. Across four studies (n=116,070), inpatient costs were 1.1-12.7 times greater in patients with decompensated cirrhosis than in those with compensated cirrhosis, and outpatient costs were 1.2-2.0 times greater. In one study (n=69,380), patients with decompensated cirrhosis had more healthcare interactions annually than those with compensated cirrhosis who, in turn, had more interactions than patients with MASH without cirrhosis (interactions, mean: 59.8 vs 37.3 vs 32.1; p<0.05). One study (n=1142) reported indirect costs in Denmark; compared with individuals without MASH, patients with MASH with and without cirrhosis were 7.2 and 4.4 times more likely to receive disability insurance, respectively.
CONCLUSIONS: This SLR suggests that total healthcare costs in MASH can be more than 2.5 times higher for those with cirrhosis than for those without, and that the economic burden is greater in decompensated than in compensated cirrhosis. Further studies are needed to quantify the economic and societal impact of MASH with cirrhosis.
METHODS: In this systematic literature review (SLR), Embase, MEDLINE and the Cochrane Library were searched for clinical trials, observational studies and SLRs/meta-analyses reporting relevant outcomes in patients with cirrhosis due to MASH, published 1 January 2014-25 July 2024.
RESULTS: Of 3397 studies screened, 317 met the inclusion criteria. Out of 35 studies reporting economic outcomes (total patients with cirrhosis: approximately N=820,000), 29 were from USA and/or Europe. Cirrhosis was associated with elevated costs. In two studies (patients with cirrhosis: n=70,522), annual healthcare costs were 1.3-2.7 times greater in MASH with cirrhosis than MASH without cirrhosis. Across four studies (n=116,070), inpatient costs were 1.1-12.7 times greater in patients with decompensated cirrhosis than in those with compensated cirrhosis, and outpatient costs were 1.2-2.0 times greater. In one study (n=69,380), patients with decompensated cirrhosis had more healthcare interactions annually than those with compensated cirrhosis who, in turn, had more interactions than patients with MASH without cirrhosis (interactions, mean: 59.8 vs 37.3 vs 32.1; p<0.05). One study (n=1142) reported indirect costs in Denmark; compared with individuals without MASH, patients with MASH with and without cirrhosis were 7.2 and 4.4 times more likely to receive disability insurance, respectively.
CONCLUSIONS: This SLR suggests that total healthcare costs in MASH can be more than 2.5 times higher for those with cirrhosis than for those without, and that the economic burden is greater in decompensated than in compensated cirrhosis. Further studies are needed to quantify the economic and societal impact of MASH with cirrhosis.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE481
Topic
Economic Evaluation, Epidemiology & Public Health, Health Technology Assessment
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), Gastrointestinal Disorders