Progression of Metabolic Dysfunction-Associated Steatohepatitis in US Adults Using Linked Records and Claims

Area of Science:

• Hepatology
• Gastroenterology
• Public Health

Background:

• Metabolic dysfunction-associated steatohepatitis (MASH) affects 5% of the global population.
• MASH can advance to end-stage liver disease (ESLD), including cirrhosis and liver cancer.
• Effective treatments are lacking, necessitating research into MASH natural history and impact.

Purpose of the Study:

• To characterize the natural history of MASH in US adults.
• To evaluate the health-care impact and costs associated with MASH progression.
• To identify predictors of progression from MASH to ESLD.

Main Methods:

• Retrospective cohort study using real-world data (Optum Market Clarity Data, Jan 2021-Mar 2024).
• Analysis of noninvasive test (NIT) use at diagnosis and during follow-up.
• Modified Poisson and Cox regression models for progression predictors and time to ESLD; multivariable regression for healthcare resource utilization (HCRU) and costs.

Main Results:

• 32.7% of 49,983 MASH patients had baseline ESLD; 15.9% of 33,624 without baseline ESLD progressed to ESLD (median 10.6 months).
• Decompensated cirrhosis was the most frequent first ESLD event.
• Older age, comorbidities (hypertension, diabetes, CVD, etc.), and smoking predicted higher progression risk; MASH progression significantly increased HCRU and costs.

Conclusions:

• Progression of MASH to ESLD is linked to substantial HCRU and costs in the US.
• Earlier identification of high-risk patients is essential.
• Targeted interventions are needed to mitigate the burden of MASH and its complications.