LIFETIME COST OF CARE SIMULATION OF COMPENSATED METABOLIC DYSFUNCTION-ASSOCIATED STEATOHEPATITIS (MASH) CIRRHOSIS
Author(s)
Nipun Atreja, MS, PhD1, Atish De, MS2, Katherine Park, MPH2, Riya Singh, BS2, Yestle Kim, MSc, PharmD1, Karen Phillips, PharmD, BCPS1, Nandini Hadker, MA2.
1Madrigal Pharmaceuticals, West Conshohocken, PA, USA, 2Trinity Life Sciences, Waltham, MA, USA.
1Madrigal Pharmaceuticals, West Conshohocken, PA, USA, 2Trinity Life Sciences, Waltham, MA, USA.
OBJECTIVES: Metabolic dysfunction-associated steatohepatitis (MASH) is a serious liver disease with high risk of adverse outcomes, particularly for patients that progress to compensated MASH cirrhosis (MASH F4c). This study investigated the progression of MASH F4c and the associated lifetime cost of care using a cohort simulation model.
METHODS: A 9-state Markov cohort model, inclusive of pre-cirrhosis fibrosis states, advanced liver disease states, liver transplant, and death, was utilized to simulate the progression of a cohort of 100,000 patients. All patients entered the model with MASH F4c and transitioned through health states in yearly cycles over a lifetime horizon (up to 40 years), using probabilities from published literature. Costs incurred were associated with treatment, disease management, monitoring, cardiovascular events, liver-related events, and mortality, sourced from published literature. Costs were inflated to 2025 USD, as necessary, and a 3% annual discount rate was applied. A scenario including use of semaglutide for 50% of patients was included.
RESULTS: The cohort simulation demonstrated that by Year 5, only 68% of all patients were alive, with 23% of all patients having progressed to more severe health states; the proportion alive decreased to approximately 50% by Year 9. Only about 23% of patients regressed to pre-cirrhosis fibrosis states (i.e., F0-F3), over the lifetime horizon. The lifetime cost of care for MASH F4c patients (median of 9 years) was $240,400 per patient. The majority (94%) of the costs were driven by disease management, including liver-related events ($226,134); The inclusion of semaglutide as concomitant baseline therapy within the model increased the total cost of care to $296,945.
CONCLUSIONS: Most patients with MASH F4c progressed to more severe health states or death. Additionally, lifetime costs are high, driven by disease management. Due in part to the lack of approved pharmacotherapies for MASH F4c, patients with MASH F4c face high clinical and economic burden.
METHODS: A 9-state Markov cohort model, inclusive of pre-cirrhosis fibrosis states, advanced liver disease states, liver transplant, and death, was utilized to simulate the progression of a cohort of 100,000 patients. All patients entered the model with MASH F4c and transitioned through health states in yearly cycles over a lifetime horizon (up to 40 years), using probabilities from published literature. Costs incurred were associated with treatment, disease management, monitoring, cardiovascular events, liver-related events, and mortality, sourced from published literature. Costs were inflated to 2025 USD, as necessary, and a 3% annual discount rate was applied. A scenario including use of semaglutide for 50% of patients was included.
RESULTS: The cohort simulation demonstrated that by Year 5, only 68% of all patients were alive, with 23% of all patients having progressed to more severe health states; the proportion alive decreased to approximately 50% by Year 9. Only about 23% of patients regressed to pre-cirrhosis fibrosis states (i.e., F0-F3), over the lifetime horizon. The lifetime cost of care for MASH F4c patients (median of 9 years) was $240,400 per patient. The majority (94%) of the costs were driven by disease management, including liver-related events ($226,134); The inclusion of semaglutide as concomitant baseline therapy within the model increased the total cost of care to $296,945.
CONCLUSIONS: Most patients with MASH F4c progressed to more severe health states or death. Additionally, lifetime costs are high, driven by disease management. Due in part to the lack of approved pharmacotherapies for MASH F4c, patients with MASH F4c face high clinical and economic burden.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE330
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)