Real-world quality of life and healthcare resource utilization in patients with metabolic dysfunction-associated steatohepatitis

Background & Aims: Metabolic dysfunction-associated steatohepatitis (MASH) is complicated by fibrosis and comorbid conditions. We investigated the real-world burden of fibrosis and additional cardiovascular renal and metabolic (CVRM) comorbidities on health-related quality of life (HRQoL) and healthcare resource utilization. Methods: Data were drawn from the Adelphi Real World MASH Disease Specific Programme™, a cross-sectional survey of physicians and patients with MASH in Canada, France, Germany, and Italy between January 2024 and June 2024. Physicians reported patient demographics and clinical characteristics. Patients voluntarily self-reported disease burden via the EQ-5D-5L and the Work Productivity and Activity Impairment (WPAI) questionnaire. Patients were grouped as: early fibrosis (stage 0–2) without additional CVRM comorbidities (EFnoC); early fibrosis with additional CVRM comorbidities (EFwC); or advanced fibrosis (stage 3–4) with additional CVRM comorbidities (AFwC). Outcomes between groups were compared statistically, with p <0.05 indicating statistical significance. Results: Overall, 247 physicians provided data for 2,675 patients, of whom 831 (31.3%) self-reported data. The mean ± SD age of patients was 55.5 ± 11.8 years, and most patients were male (60.0%). On average, patients had 3.6 ± 2.4 comorbidities, with hypertension (45.9%), dyslipidemia (42.8%), and obesity (37.5%) the most common. Mean EQ-5D-5L scores were lower for EFwC patients (0.85 ± 0.16 [n = 524]) and AFwC patients (0.81 ± 0.18 [n = 113]) compared with EFnoC patients (0.90 ± 0.12 [n = 48], p <0.05 and p <0.001, respectively). AFwC patients also experienced greater impairment while working compared with EFnoC patients (29.7 ± 26.5 [n = 35] vs. 16.1 ± 21.3 [n = 28], p = 0.0271). Conclusions: Increased disease severity exacerbated symptomatic burden in patients with MASH. This indicates a need for early interventions to prevent a reduction in quality of life and overall wellbeing. Impact and implications: Metabolic dysfunction-associated steatohepatitis (MASH) is a complex chronic liver disease with limited treatment options. Although MASH shows an increasing incidence across the globe, detailed characterization of disease burden is lacking. This global, multicentered, cross-sectional survey revealed significantly worse HRQoL, productivity, and increased healthcare resource utilization outcomes for patients with MASH with more advanced fibrosis compared with those with MASH with less advanced fibrosis. Further additional cardiovascular, metabolic, and renal comorbidities in patients with MASH were associated with a quality-of-life reduction. Thus, physicians and healthcare payers should be aware of the increased humanistic and productivity burdens faced by patients. With this knowledge, more proactive treatment approaches could be implemented to limit MASH progression and maximize patient quality of life.