Cirrhosis Linked to Greater Health Care Cost, Comorbidity Burden in MASH

Findings from a recent study are providing clinicians with an overview of the health and economic burden of metabolic dysfunction–associated steatohepatitis (MASH), especially among patients with cirrhosis.¹

Results highlight a greater prevalence of comorbidities among individuals with MASH and cirrhosis, suggesting preventing progression to cirrhosis should be a main focus of clinical care. Additionally, patients with cirrhosis had significantly greater annual total health care costs, largely driven by inpatient costs.¹

“Despite growing evidence regarding the high health care costs and utilization associated with MASH, there remains an unmet need to better understand how MASH severity (including the absence or presence of cirrhosis) and the presence of associated comorbidities affect health economics,” Zobair Younossi, MD, a chairman on the Global NASH Council, and colleagues wrote.¹

MASH, formerly known as nonalcoholic steatohepatitis (NASH), is an advanced form of metabolic dysfunction-associated steatotic liver disease (MASLD) leading to inflammation of the liver that can eventually cause cirrhosis and lead to liver failure. The primary risk of MASH is progressive fibrosis leading to cirrhosis, which occurs in 5% to 12% of people with MASH. However, the specific health and economic burdens of cirrhosis in MASH are not well understood.²

To investigate the demographic and clinical characteristics, economic burden, and factors influencing the economic burden in MASH, investigators conducted a retrospective, observational study using anonymized data from the IQVIA Ambulatory electronic medical record-US with linked PharMetrics Plus claims, a large, commercially available US health care dataset which collates data from physician practices for about 71 million patients. Patients ≥18 years of age who had ≥ 1 claim associated with MASH diagnosis (identified using the ICD-10 codes) between October 1, 2015, and June 30, 2023, were included. Investigators stratified patients based on the presence of cirrhosis, defined as having an ICD-9 or ICD-10-CM diagnosis related to cirrhosis, in the 12-month baseline period or at the time of index into cirrhosis and no-cirrhosis groups.¹

The primary outcomes were the baseline demographics and clinical characteristics of the cirrhosis and no-cirrhosis groups from the 12-month period prior to the index, including the prevalence of comorbidities and claims associated with concomitant medications. Another primary outcome was the annualized total health care cost incurred during follow-up for both the cirrhosis and no-cirrhosis groups, including the proportion of patients in different thresholds of total health care cost burden: ≥$5000 per annum, ≥$15,000 per annum, and ≥$50,000 per annum. Furthermore, patients in both groups were stratified as having either a high-cost burden, defined as an annual total health care cost higher than the average medical costs in the United States ($13,555 per capita per annum), or a non-high–cost burden.¹

In total, 16,919 patients were included in the analysis, including 2034 with cirrhosis and 14,885 without. Among the entire cohort, the mean age was 52.1 (Standard deviation [SD], 11.7) years and 53% of patients were female. Investigators noted the mean FIB-4 score was significantly greater in the cirrhosis group compared with the no-cirrhosis group (3.60 vs 1.38; P <.0001), also observing a greater proportion of patients in the cirrhosis group with a high risk of advanced fibrosis (FIB-4 >2.67) compared with the no-cirrhosis group (3% vs 0%).¹

Comorbidities were prevalent across both groups. In the no-cirrhosis group, the most common were hyperlipidemia/dyslipidemia (65%), hypertension (63%), and obesity (56%). In the cirrhosis group, the most common were hypertension (79%), type 2 diabetes (71%), and hyperlipidemia/dyslipidemia (68%). Of note, the prevalence of all individual comorbidities, except for anxiety and rheumatoid arthritis, was significantly greater in the cirrhosis group (P <.005).¹

Investigators also pointed out annual total health care costs were increased in patients with cirrhosis compared to those without ($98,574 vs $39,568). Even after adjustment for age, sex, US region, insurance type, and comorbidities, mean follow-up costs remained higher for the cirrhosis versus no-cirrhosis group (P <.0001). Additionally, more patients with cirrhosis had a high-cost burden (≥$13,555) than patients without cirrhosis (70% vs 40%).¹

Investigators pointed out the prevalence of comorbidities at baseline was significantly greater in patients with a high-cost burden (P <.0001), and the total follow-up costs increased as the number of comorbidities increased. Additionally, they noted the use of glucose-lowering treatment (43% of patients with high-cost vs 21% of patients with non-high–cost) and CV-related medication (72% vs 58%, respectively) was greater in the high-cost group compared with the non-high–cost group.¹

Further analysis revealed MASH diagnosis was associated with an increase in cost, largely driven by inpatient costs. In patients with cirrhosis, the total mean patient costs for all-cause disease at baseline and follow-up after MASH diagnosis were $43,118 and $98,574, respectively, compared to $17,951 and $39,568 for patients without cirrhosis.¹

Investigators outlined limitations to these findings, including the potential for missing/misclassified data pertaining to MASH diagnosis; possible inconsistencies in cirrhosis identification; and other inherent limitations of the observational, retrospective nature of the study.¹

“These results complement previous findings demonstrating that early diagnosis and prevention of disease progression could reduce the comorbidity and economic burden associated with MASH,” investigators concluded.¹ “In addition, the results illustrate the economic burden in noncirrhotic MASH and, together with previously published literature, indicate that factors contributing to increased economic burden are also clinically relevant, which may help to better manage this disease stage and reduce the burden on patients and health care systems.”

References

1. ^{Younossi ZM, Mangla KK, Chandramouli AS, et al. Estimating the economic impact of comorbidities in patients with MASH and defining high-cost burden in patients with noncirrhotic MASH. Hepatology Communications. doi:10.1097/HC9.0000000000000488}
2. ^{Cleveland Clinic. Metabolic Dysfunction-Associated Steatohepatitis. Diseases & Conditions. May 3, 2022. Accessed July 26, 2024. https://my.clevelandclinic.org/health/diseases/22988-nonalcoholic-steatohepatitis}