Real‐World Cost and Utilisation Burden of Diagnosed Metabolic Dysfunction‐Associated Steatotic Liver Disease in Patients With Type 2 Diabetes in the United States: A Retrospective Cohort Study

ABSTRACT Aims This study quantified the real‐world healthcare costs and utilisation associated with diagnosed metabolic dysfunction‐associated steatotic liver disease (MASLD) among adults with Type 2 diabetes (T2D). Methods We conducted a retrospective cohort study using IQVIA PharMetrics Plus Closed Health Plan data from January 2016 to June 2025. Eligible participants were adults aged 18–64 years with T2D. MASLD was identified during the baseline period, and patients with MASLD were matched 1:1 to T2D‐only controls using propensity scores. The primary outcome was all‐cause total direct healthcare costs over 12 months of follow‐up. Adjusted cost ratios (aCRs) and average marginal effects (AMEs) were estimated using generalised linear models. Results The final cohort included 155 172 adults with T2D. After PS matching, 17 412 matched pairs were retained. Mean total healthcare costs were $29 734 among patients with MASLD and $18 320 among matched controls. MASLD was associated with 62% higher total healthcare costs (aCR, 1.62; 95% CI, 1.58–1.67), corresponding to an AME of $11 411 (95% CI, $10 725–$12 097) per patient per year. In medication‐defined subgroups, excess costs remained substantial among patients receiving GLP‐1 receptor agonists (AME, $10 653) and SGLT2 inhibitors (AME, $13 842). MASLD was also associated with greater healthcare utilisation across all service settings. Conclusions Among adults with T2D, MASLD was associated with substantially higher healthcare costs and utilisation. These findings highlight the economic burden of MASLD in this high‐risk population.