MASH Disease Progression Associated With Increased Economic Burden Among Medicare Beneficiaries
Key Takeaways:
- In an analysis of 257 201 Medicare fee-for-service (FFS) beneficiaries, patients with metabolic dysfunction-associated steatohepatitis (MASH) had higher health care utilization and medical costs compared to those without MASH.
- Patients with cirrhotic MASH (C-MASH) had significantly higher hospitalizations compared to those with noncirrhotic MASH (NC-MASH), which resulted in $15 639 higher total medical costs.
- Based on these findings, MASH is estimated to cost Medicare $645 million annually, highlighting the need for improved early intervention and disease management to slow progression.
While previous research has demonstrated the economic and clinical burden associated with MASH, few studies have examined its real-world impact on health care utilization and medical costs.
Study Methods and Outcomes
Researchers conducted an observational, retrospective cohort study of Medicare FFS beneficiaries aged 65 years or older using 100% Medicare FFS claims data from January 2016 to December 2022.
The primary outcome was to compare health care utilization and medical costs between patients with MASH and those without MASH. Secondary outcomes included comparisons between patients with C-MASH and NC-MASH as well as between patients with decompensated cirrhosis (DCC-MASH) and compensated cirrhosis (CC-MASH).
Participants were categorized into 1 of 6 cohorts according to disease status. The main cohorts included beneficiaries with MASH and those without MASH. Within the MASH cohort, patients were assigned to either the C-MASH or NC-MASH subgroup. The C-MASH cohort was divided further to differentiate patients with DCC-MASH and patients with CC-MASH.
Patient Characteristics
The study included a total of 257 201 Medicare beneficiaries, of whom 128 622 had MASH and 128 579 did not have MASH. Among patients with MASH, 52 883 were in the C-MASH cohort, and 74 910 were in the NC-MASH cohort. Among those in the C-MASH cohort, 38 144 had DCC-MASH, and 13 288 had CC-MASH.
Beneficiaries with MASH had higher rates of comorbidities compared to those without MASH. The most common comorbidities included type 2 diabetes (T2D), hyperlipidemia, and atherosclerotic cardiovascular disease. In addition, T2D was more prevalent among patients in the C-MASH cohort compared to those in the NC-MASH cohort.
Utilization and Costs of MASH vs Non-MASH
In the weighted analysis, beneficiaries with MASH had significantly higher health care utilization compared to those without MASH.
Compared to non-MASH, patients with MASH had 36% more all-cause hospitalizations, 26% more emergency department (ED) visits, and 12% more outpatient visits.
The MASH cohort had a 10-fold increase in liver-related hospitalizations compared to the non-MASH cohort.
In terms of total medical costs, the MASH cohort had an average of $2150 per patient per year (PPPY) more than the non-MASH cohort, with hospitalizations being the primary driver of cost. Liver-related costs were similar, with MASH patients spending an additional $2397 compared to non-MASH beneficiaries.
Utilization and Costs of C-MASH vs NC-MASH
Compared to the NC-MASH cohort, the C-MASH cohort saw a 2-fold increase in all-cause hospitalizations and ED visits. Liver-related hospitalizations increased 18-fold, and ED visits increased 2-fold among patients with C-MASH.
Patients with C-MASH incurred higher medical costs compared to those with NC-MASH, with an average difference of $15 639 PPPY in total costs, $8402 PPPY in liver-related costs, and $1079 PPPY in cardiovascular-related costs. Costs were mainly driven by hospitalizations and outpatient visits.
Implications for Managed Care
These findings demonstrate the economic burden associated with MASH, which increases based on disease severity and progression. Among Medicare beneficiaries, those with MASH had increased health care utilization and costs, especially among those with C-MASH.
Based on this data, annual total costs associated with MASH among Medicare FFS beneficiaries estimate to approximately $645 million.
The authors said, “Overall, this study bridged an important real-world evidence gap and underscored the urgent need for improved prevention, diagnosis, and earlier management of MASH to reduce its incidence and the associated resource utilization and healthcare costs.”
Reference
Albarmawi H, Tan A, Aly A, et al. The healthcare resource utilization and costs associated with metabolic dysfunction-associated steatohepatitis among Medicare beneficiaries: a retrospective cohort study. J Med Econ. 2026;29(1):498-515. doi:10.1080/13696998.2026.2630601
