Healthcare costs of managing <scp>MAFLD</scp> are mostly driven by hospitalisation and advanced fibrosis: cost‐analysis from a tertiary‐care, multi‐disciplinary <scp>MAFLD</scp> clinic

BACKGROUND AND AIMS: Patients with metabolic (dysfunction)-associated fatty liver disease (MAFLD) are frequently multimorbid, putting upward pressure on healthcare costs compared to other liver diseases. As Australian data are limited on expenditures in managing MAFLD, we evaluated hospital-related costs and predictors of costs in patients managed in a dedicated MAFLD clinic. METHODS: We conducted a retrospective review of adults attending a MAFLD clinic in Melbourne, Australia between January 2017 and December 2020. A control cohort of chronic hepatitis B (CHB) patients provided disease context. We analysed direct healthcare utilisation and costs categorised by specialty, hospital setting and fibrosis stage. Multivariate Poisson regression identified independent predictors of increased healthcare utilisation. Multivariate linear regression analysis identified independent predictors of healthcare cost. RESULTS: A total of 310 MAFLD and 261 CHB patients were followed up over a median 1.93 vs 4.06 years (P < 0.001). Advanced fibrosis/cirrhosis (F3-4) represented 26% MAFLD patients and 9% CHB patients accounting for 54.9% and 18.2% total expenditure respectively. Inpatient utility was greater in MAFLD compared to CHB (6.1% vs 0.4%, P < 0.001), as was proportion of hospitalisation costs (48.3% vs 0.8%, P < 0.001). Independent predictors of cost in MAFLD were obstructive sleep apnea (P < 0.01), cardiovascular disease (P = 0.04) and F3-4 (P < 0.001), which also predicted liver-related outpatient appointments and radiology (P < 0.001 for both). CONCLUSIONS: The greatest healthcare-related costs for MAFLD clinic patients are incurred through hospitalisation, with F3-4 predicting a disproportionately high economic burden. Our findings demonstrate the association between metabolic comorbidities and liver disease progression in MAFLD, highlighting a research gap of integrated care provision to optimise resource allocation.