Clinical and humanistic burden of metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis in the United States: a system dynamics model
Date:
This study estimates the clinical and patient burden of MASLD/MASH in the US, based on a dynamic prevalence model calibrated to NHANES-derived prevalence data for 2006-2020. Assuming the status quo continues, prevalence is predicted to rise from 104m in 2025 to 133m by 2060, with an associated 131% increase in the demand for liver transplantation and a 36% increase in deaths relating to the disease.
Abstract: Metabolic dysfunction–associated steatotic liver disease (MASLD) can progress to metabolic dysfunction–associated steatohepatitis (MASH), characterized by inflammation, progressive liver damage and scarring. This study aimed to predict the system impact of MASLD/MASH prevalence on the clinical and humanistic burden based on current standard of care practices in the US.
A US system dynamics model was developed to predict the prevalence and burden of MASLD/MASH and its complications, stratified by age and disease stage, from 2025 to 2060. The model was calibrated to National Health and Nutrition Examination Survey (NHANES)-derived data (2006–2020) and annual liver transplant incidence data from the Scientific Registry of Transplant Recipients (2012–2020) and validated by two clinical experts. Model outcomes included mortality, cardiovascular (CV) complications, liver transplants, hepatocellular carcinomas (HCCs), health-related quality of life (HRQoL), and lost productivity.
Under current standard of care practices in the US, MASLD/MASH prevalence is projected to increase by 28%, from 104 million in 2025 to 133 million in 2060. Results suggest that people with MASH F2-F4 will drive the burden, with the greatest percentage increase occurring for F3 (126%) and F4 (116%). The annual incidence of liver transplants attributable to MASH cirrhosis is projected to increase by 131%, from 1,439 in 2025 to 3,317 liver transplants in 2060. Annual excess mortality is projected to increase from 0.95 million deaths associated with MASLD/MASH and its complications in 2025, to 1.3 million in 2060, an increase of 36%. This reflects worsening disease severity, with excess mortality for F4 increasing by 98%.
Annual CV complications will rise by 28% by 2060, whereas HCC incidence will increase by 166%. The HRQoL burden from MASLD/MASH is projected to rise from 4.7 million years of perfect health lost in 2025 to 6.1 million in 2060. Absenteeism due to morbidity is projected to increase by 18%, reaching 615 million workdays in 2060, worth $158 billion. In 2060, MASH F4 is projected to represent approximately 0.7% of the population but account for 6.0% of excess deaths and 34.1% of HCCs.
Under current standard of care practices, the clinical and humanistic burden of MASLD/MASH is projected to rise substantially in the US, emphasizing the urgent need for earlier detection and intervention strategies.
Recommended citation: Dinani, A., de Laguiche, E., Tefos, F., Victor, D., Wilczynski, F., Padgett, T. (2026) Clinical and humanistic burden of metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis in the United States: a system dynamics model. EASL 2026, 27 May 2026; Poster.