(184) Real-world healthcare resource utilization and costs among 100% Fee-For-Service Medicare beneficiaries with metabolic dysfunction-associated steatohepatitis

Background: : The healthcare burden of metabolic dysfunction-associated steatohepatitis (MASH) among Medicare beneficiaries remains under-documented.

Objective: : This study sought to estimate all-cause healthcare resource utilization (HCRU) and costs among Medicare Fee-for-Service (FFS) beneficiaries with diagnosed MASH vs those without diagnosed MASH.

Methods: : This observational study utilized 100% Medicare FFS claims to assess HCRU and costs associated with MASH among those ≥66 years of age from Jan. 1, 2016 to Dec. 31, 2022. The MASH cohort included those with ≥1 ICD-10-CM diagnosis code of K75.81. The non-MASH cohort was a random sample of those without a MASH diagnosis that was five times the size of the MASH cohort. Stabilized inverse probability weighting (IPW) for MASH status was used to adjust for differences in baseline covariates, including differences in cardiometabolic conditions. Baseline characteristics were summarized descriptively, and IPW all-cause HCRU and costs during follow-up were reported as visits and costs (in 2022 USD) per-patient per-year (PPPY).

Results: : The study included 128,622 beneficiaries in the MASH cohort and 642,774 in the non-MASH cohort. Prior to IPW, those with MASH were younger (mean age: 73.4 vs 74.7 years), included more females (60.4% vs 56.8%), and with more cardiometabolic conditions including type 2 diabetes (58.3% vs 26.6%), obesity (45.3% vs 16.5%), and atherosclerotic cardiovascular disease (43.9% vs 31.9%). After IPW, MASH was associated with higher HCRU PPPY, including 48% greater inpatient (IP) visits (0.39 vs 0.26), 20% greater outpatient (OP) visits (37.47 vs 31.31), 32% greater emergency department (ED) visits (0.80 vs 0.60), 20% greater skilled nursing facility (SNF)/hospice visits (0.22 vs 0.18), and 7% greater prescription fills (31.81 vs 29.66). Total costs PPPY were 21% higher for MASH vs non-MASH ($24,890 vs $20,542), including OP ($11,107 vs $9,565), IP ($6,855 vs $4,604), ED ($635 vs $498), SNF/hospice ($1,874 vs $1,653), and prescription costs ($4,634 vs $4,039). All HCRU and cost differences and ratios were statistically significant based on a p< 0.05.

Conclusions: : Among older Medicare beneficiaries, HCRU and costs were greater among those with diagnosed MASH compared to those without diagnosed MASH, likely due to management of liver disease which may include advanced liver fibrosis or cirrhosis. Understanding the real-world healthcare burden of MASH is important for guiding healthcare decisions including treatment and screening.

Sponsorship:: Novo Nordisk, Inc.