Economic and healthcare resource burden of metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis: a United States system dynamics model
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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 37% increase in direct costs and 39% increase in bed days.
Abstract: Metabolic dysfunction-associated steatotic liver disease (MASLD) is projected to increase globally and impact a third of the United States (US) population. Metabolic dysfunction-associated steatohepatitis (MASH), characterized by hepatic steatosis, inflammation, hepatocyte injury and fibrosis, is associated with all cause and liver related mortality. This study aimed to predict the impact of rising MASLD/MASH prevalence on direct costs and healthcare resource utilization (HCRU), 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. Disease stage was derived by mapping Fibrosis-4 (FIB-4) to fibrosis stage (F-stage). The model was calibrated to National Health and Nutrition Examination Survey (NHANES)-derived data (2006–2020) and validated by two clinical experts. Model outcomes included direct healthcare costs and HCRU, including primary care contacts and hospital bed days.
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. People with MASH F2-F4 drive the projected burden, with the greatest percentage increase occurring for F3 (126%) and F4 (116%). The total annual direct costs attributable to MASLD/MASH are predicted to increase from $1.8 trillion in 2025, to $2.5 trillion in 2060, an increase of 37%. Of this, $38 billion is attributed to individuals with F4 fibrosis.#
Annual HCRU attributable to MASLD/MASH is projected to rise, with primary care visits increasing by 29% and hospital bed days by 39%, growing from 1.0 billion and 98 million in 2025, to 1.3 billion and 137 million by 2060, respectively. In 2060, people with MASH F4 would represent approximately 0.7% of the MASLD/MASH population and account for 12.4 million primary care visits and 6.6 million hospital bed days.
The economic and HCRU burden of MASLD/MASH is projected to rise substantially under current standard of care practices in the US, driven by increasing prevalence and disease severity. This underscores an urgent need for intervention and prevention strategies to mitigate the impact of MASLD/MASH.
Recommended citation: Victor, D., Dinani, A., de Laguiche, E., Tefos, F., Wilczynski, F., Padgett, T. (2026) Economic and healthcare resource burden of metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis: a United States system dynamics model. EASL 2026, 30 May 2026; Poster.