Burden of metabolic dysfunction-associated steatohepatitis, with and without metabolic syndrome, obesity, or diabetes

BACKGROUND: Metabolic dysfunction-associated steatohepatitis (MASH) is commonly comorbid with metabolic syndrome; however, MASH can occur in the absence of metabolic syndrome. This retrospective cohort study evaluated the patient characteristics, healthcare utilization, and healthcare costs among patients with MASH with and without metabolic syndrome, obesity, and type 2 diabetes/elevated fasting glucose. METHODS: In a linked dataset of electronic health records (Veradigm Network EHR) and claims (Komodo Health), we identified adults with a MASH diagnosis code (7/1/2018-3/15/2023) and ≥12 months of continuous enrollment pre- and post-MASH diagnosis. Patients with other causes of liver disease, gestational or type 1 diabetes, or bariatric surgery were excluded. Six cohorts were identified: 1) MASH with metabolic syndrome, 2) MASH without metabolic syndrome, 3) MASH with body mass index (BMI) <25, 4) MASH with a BMI <25 and metabolic syndrome, 5) MASH with a BMI <25 without metabolic syndrome, and 6) MASH with a BMI <25 without metabolic syndrome or type 2 diabetes/elevated fasting glucose. We captured demographics, clinical characteristics, all-cause healthcare utilization, and costs. RESULTS: We identified 98,199 patients with MASH, of which 34.4% did not have metabolic syndrome, and 3.1% had a BMI <25. Mean (standard deviation) annualized all-cause healthcare costs exceeded $19,000 in all cohorts and ranged from $19,018 ($60,359) among patients with a BMI <25 without metabolic syndrome or type 2 diabetes/elevated fasting glucose to $32,592 ($337,462) among patients with metabolic syndrome. Median (interquartile range) costs ranged from $5,336 ($2,085-$14,839) to $11,373 ($4,478-$27,243), and mean costs after excluding the top 1% of spenders ranged from $14,355 ($25,868) to $21,878 ($30,755). Trends were consistent when the analysis was expanded to include patients without a documented BMI. CONCLUSIONS: Metabolic syndrome is commonly comorbid with MASH; however, all-cause healthcare costs remain high even among the subpopulation without metabolic syndrome, elevated BMI, or type 2 diabetes/elevated fasting glucose.