The healthcare resource utilization and costs associated with metabolic dysfunction-associated steatohepatitis among Medicare beneficiaries: a retrospective cohort study

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AIMS: The main objective of this study was to estimate the incremental healthcare resource utilization (HCRU) and costs attributable to metabolic dysfunction-associated steatohepatitis (MASH) from a Medicare fee-for-service perspective by comparing beneficiaries diagnosed with MASH with those not diagnosed with MASH. MATERIAL AND METHODS: This observational study used 100% Medicare fee-for-service claims data from January 1, 2016, through December 31, 2022. The study population was stratified in cohorts based on MASH status. In the main analysis, the MASH cohort included all beneficiaries diagnosed with MASH, while the non-MASH cohort comprised a random sample of beneficiaries without a MASH diagnosis, matched in size to the MASH cohort. To compare the 2 cohorts, stabilized inverse probability of treatment weighting (IPTW) was used to adjust for differences in baseline covariates, including selected cardiometabolic conditions. Reported outcomes included all-cause, cardiovascular-related, and liver-related HCRU and costs after IPTW. RESULTS: The study included 128 622 beneficiaries in the MASH cohort and 128 579 beneficiaries in the non-MASH cohort. After IPTW, MASH was associated with higher all-cause HCRU rates, particularly for inpatient hospitalizations (rate ratio, 1.36; 95% CI, 1.33-1.39). This increase appeared to be driven by liver-related hospitalizations (rate ratio, 10.41; 95% CI, 9.40-11.42). Consistent with HCRU findings, mean total cost per patient per year was higher for MASH compared with non-MASH ($27 816 vs $25 666; mean cost difference, $2150; 95% CI, $1673-$2627). LIMITATIONS: The HCRU and cost attributed to MASH could be underestimated because of MASH underdiagnosis and underreporting, as well as potential overadjustment for MASH-driven comorbidities in the IPTW model. CONCLUSIONS: Among Medicare fee-for-service beneficiaries aged 66 years and older, MASH was associated with significantly greater HCRU and costs, even after adjustment for cardiometabolic and other comorbidities. The higher HCRU and costs are likely driven by the management of liver disease, which may include cirrhosis and hepatic decompensation.

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