EPIDEMIOLOGICAL, CLINICAL, ECONOMIC, AND HUMANISTIC BURDEN OF METABOLIC DYSFUNCTION-ASSOCIATED STEATOHEPATITIS (MASH) IN THE UNITED ARAB EMIRATES: A MARKOV STATE-TRANSITION MODELING STUDY
Author(s)
Shiva Kumar, Medical Doctor, Gastroenterology and Hepatology1, Elamin Abdelgadir, Medical Doctor, Endocrinology2, Farooq Khan, Medical Doctor, Gastroenterology and Hepatology3, Sahar Fahmy, Bsc, PhD4, Hossam Magdy, BPharm, Msc5, Yacine Amirouche, PharmD, Msc5, Basem Elbramawy, BPharm, MBA5, Hind Hajj, RPh, Msc.6.
1Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates, 2Mohammed Bin Rashid University Hospital, Dubai, United Arab Emirates, 3King's College, Dubai, United Arab Emirates, 4Department of Health, Abu Dhabi, United Arab Emirates, Abu Dhabi, United Arab Emirates, 5Novo Nordisk, Dubai, United Arab Emirates, 6Masdar Al Hekmah, Riyadh, Saudi Arabia.
1Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates, 2Mohammed Bin Rashid University Hospital, Dubai, United Arab Emirates, 3King's College, Dubai, United Arab Emirates, 4Department of Health, Abu Dhabi, United Arab Emirates, Abu Dhabi, United Arab Emirates, 5Novo Nordisk, Dubai, United Arab Emirates, 6Masdar Al Hekmah, Riyadh, Saudi Arabia.
OBJECTIVES: Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive liver disease driven by obesity, type 2 diabetes, and cardiometabolic risk. The UAE's high prevalence of these conditions places it at significant risk, while MASH remains largely underdiagnosed due to its silent progression until advanced liver disease develops. The objective is to quantify the burden of MASH in the UAE over a 30-year lifetime horizon, adopting both payer and societal perspectives.
METHODS: A cohort-based Markov state-transition model simulated lifetime disease progression in adults with diagnosed MASH. Health states included fibrosis stages (F0-F4), compensated cirrhosis (CC), decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), liver transplant (LT), and death, with comorbidities incorporated. UAE-specific inputs, published evidence, and local costs informed transitions, utilities, healthcare, and productivity losses. Outcomes included disease distribution, mortality, healthcare costs, life-years (LYs), and quality-adjusted life-years (QALYs) lost.
RESULTS: The modeled cohort comprised 1,528,021 adults with diagnosed MASH at baseline; 772,801 (50.6%) reached the death state over the 30-year horizon. Disease progression was substantial: the prevalence of advanced fibrosis (F4) rose from 7% at cohort entry to 30% by model end. Within the F4 health state, 17% of individuals developed CC, 6% DC, 5% HCC, and 2% underwent LT. Liver-related causes accounted for the greatest share of mortality, followed by cardiovascular events and obesity-associated malignancy. Among those surviving to model end, major adverse cardiovascular events, specifically myocardial infarction and stroke, constituted the dominant residual comorbidity burden. The total discounted economic burden over the model horizon reached AED 1.15 trillion, encompassing 9.3 million LYs and 15.0 million QALYs lost
CONCLUSIONS: MASH carries a substantial economic burden in the UAE, with half of diagnosed individuals dying within the modeled 30-year horizon. Progression from F4 fibrosis to DCC, HCC, and LT drives most costs and mortality, underscoring the need for structured screening and early intervention to prevent irreversible disease.
METHODS: A cohort-based Markov state-transition model simulated lifetime disease progression in adults with diagnosed MASH. Health states included fibrosis stages (F0-F4), compensated cirrhosis (CC), decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), liver transplant (LT), and death, with comorbidities incorporated. UAE-specific inputs, published evidence, and local costs informed transitions, utilities, healthcare, and productivity losses. Outcomes included disease distribution, mortality, healthcare costs, life-years (LYs), and quality-adjusted life-years (QALYs) lost.
RESULTS: The modeled cohort comprised 1,528,021 adults with diagnosed MASH at baseline; 772,801 (50.6%) reached the death state over the 30-year horizon. Disease progression was substantial: the prevalence of advanced fibrosis (F4) rose from 7% at cohort entry to 30% by model end. Within the F4 health state, 17% of individuals developed CC, 6% DC, 5% HCC, and 2% underwent LT. Liver-related causes accounted for the greatest share of mortality, followed by cardiovascular events and obesity-associated malignancy. Among those surviving to model end, major adverse cardiovascular events, specifically myocardial infarction and stroke, constituted the dominant residual comorbidity burden. The total discounted economic burden over the model horizon reached AED 1.15 trillion, encompassing 9.3 million LYs and 15.0 million QALYs lost
CONCLUSIONS: MASH carries a substantial economic burden in the UAE, with half of diagnosed individuals dying within the modeled 30-year horizon. Progression from F4 fibrosis to DCC, HCC, and LT drives most costs and mortality, underscoring the need for structured screening and early intervention to prevent irreversible disease.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE628
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas