The Economic Burden of Metabolic Dysfunction‐Associated Steatohepatitis ( <scp>MASH</scp> ) With Cirrhosis: A Systematic Review

ABSTRACT Background &amp; Aims The clinical burden of metabolic dysfunction‐associated steatohepatitis (MASH) is substantial and there are no approved treatments for patients with cirrhosis. This systematic review aimed to better understand the economic burden in this population. Methods The review observed PRISMA guidelines and was registered with PROSPERO (CRD4202458650). Embase, MEDLINE, and the Cochrane Library were searched for clinical trials, observational studies and systematic reviews/meta‐analyses published since 1 January 2014 in individuals with cirrhosis due to MASH. Results Of 4011 publications identified, 317 were included. Data were extracted from 35 studies reporting economic outcomes, predominantly direct healthcare costs and healthcare resource utilization (HCRU). Among populations with MASH, total healthcare costs were 1.3–2.7 times higher in those with cirrhosis than without, and outpatient and inpatient costs were up to 13 times higher in decompensated cirrhosis than compensated cirrhosis. A similar trend was observed for HCRU. Five studies reported increases in annual or monthly per‐person healthcare costs following a MASH with cirrhosis diagnosis, and patient characteristics linked to cost differences in MASH with cirrhosis included age, ethnicity and fibrosis‐4 index score. One study reporting indirect costs found that individuals with cirrhosis due to MASH had a lower income and were more likely to take early retirement compared with matched controls. Conclusions Our findings illustrate the economic burden of MASH with cirrhosis, highlighting potential evidence gaps, including the indirect economic burden. Better understanding of the burden associated with cirrhosis due to MASH will help to inform cost–benefit analyses of existing and future interventions.