Comorbid type 2 diabetes and cardiovascular disease drive higher healthcare costs in MASLD/MASH: a retrospective Swedish cohort study

OBJECTIVES: We compared healthcare resource utilization (HCRU) and healthcare costs in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic dysfunction-associated steatohepatitis (MASH) with or without obesity, type 2 diabetes (T2D) or cardiovascular disease (CVD). METHODS: This cohort study included adults with biopsy-confirmed MASLD/MASH from three Swedish university hospitals (1974-2020). Clinical data were linked to national registers to capture long-term outcomes, HCRU and costs. In addition to the overall cohort, patients were stratified into comorbidity-positive and comorbidity-negative subgroups for obesity, T2D and CVD. HCRU outcomes were hospitalizations, length of stay and outpatient visits. Total costs were the sum of direct costs (hospitalizations, outpatient visits, prescribed drugs) and indirect costs (sickness, early retirement benefits). Negative binomial and generalized linear models were used to estimate adjusted annual HCRU and costs, respectively. RESULTS: Among 959 patients, 40%, 25% and 11% were living with obesity, T2D and CVD, respectively. Patients with T2D or CVD had more advanced fibrosis at baseline and a higher incidence of cirrhosis or hepatocellular carcinoma during follow-up (up to 46 years depending on outcome), compared with those without T2D or CVD. T2D and CVD were linked to substantially greater HCRU and costs: mean annual total costs were approximately 76% higher for CVD and 71% higher for T2D compared with subgroups without these comorbidities. CONCLUSIONS: T2D and CVD are linked to an increased economic burden in MASLD/MASH. Holistic, multidisciplinary management is essential to help mitigate disease progression and the associated clinical and economic burden.