Health care resource utilization and cost of metabolic dysfunction–associated steatotic liver disease (MASLD) in Ontario, Canada: An observational study

Abstract Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is increasingly prevalent and associated with substantial clinical and economic burden; real‒world data on its impact in Canada remain limited. The objective is to describe the health care resource utilization (HCRU) and direct health care costs of persons with MASLD (PwMASLD) in Ontario. Methods: PwMASLD in Ontario were identified using administrative data from January 1, 2013, to December 31, 2021, and followed until December 31, 2022. PwMASLD were categorized into mutually exclusive subgroups: MASLD-only without MASH and cirrhosis, MASH without cirrhosis, and MASLD/MASH with cirrhosis . PwMASLD were matched with controls (without MASLD) on age, sex, geography, and income quintile. All-cause HCRU and costs were described. Results: Mean age of PwMASLD was 53.4 (SD 17.2) years, and 56% of participants were female. PwMASLD had greater than twofold higher HCRU versus controls. MASLD-only, MASH, and cirrhosis subgroups comprised 12,729 (70%), 2,675 (15%), and 2,798 (15%) PwMASLD. HCRU was highest in the cirrhosis subgroup, followed by MASH and MASLD-only subgroups. Physician visits were the most used health care resource category across subgroups. Annual costs were higher for PwMASLD than controls (CAD$15,905 versus $4,605). Mean annual costs were highest for the cirrhosis subgroup (CAD$33,442) (MASH, CAD$18,059; MASLD-only, CAD$12,187). In-patient hospitalization was the highest-cost category across subgroups. PwMASLD with liver and/or cardiovascular outcomes had over twice the HCRU and costs versus those without outcomes. Conclusions: PwMASLD identified from Ontario administrative data had higher HCRU and costs than controls; greatest burden was observed among those with cirrhosis. Strategies to delay progression through prevention, early identification, and intervention are essential to reduce MASLD's economic impact.