Real-World Cost and Utilisation Burden of Diagnosed Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients With Type 2 Diabetes in the United States: A Retrospective Cohort Study.

AIMS: This study quantified the real-world healthcare costs and utilisation associated with diagnosed metabolic dysfunction-associated steatotic liver disease (MASLD) among adults with Type 2 diabetes (T2D). METHODS: We conducted a retrospective cohort study using IQVIA PharMetrics Plus Closed Health Plan data from January 2016 to June 2025. Eligible participants were adults aged 18-64 years with T2D. MASLD was identified during the baseline period, and patients with MASLD were matched 1:1 to T2D-only controls using propensity scores. The primary outcome was all-cause total direct healthcare costs over 12 months of follow-up. Adjusted cost ratios (aCRs) and average marginal effects (AMEs) were estimated using generalised linear models. RESULTS: The final cohort included 155 172 adults with T2D. After PS matching, 17 412 matched pairs were retained. Mean total healthcare costs were $29 734 among patients with MASLD and $18 320 among matched controls. MASLD was associated with 62% higher total healthcare costs (aCR, 1.62; 95% CI, 1.58-1.67), corresponding to an AME of $11 411 (95% CI, $10 725-$12 097) per patient per year. In medication-defined subgroups, excess costs remained substantial among patients receiving GLP-1 receptor agonists (AME, $10 653) and SGLT2 inhibitors (AME, $13 842). MASLD was also associated with greater healthcare utilisation across all service settings. CONCLUSIONS: Among adults with T2D, MASLD was associated with substantially higher healthcare costs and utilisation. These findings highlight the economic burden of MASLD in this high-risk population.