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Research Article
22 July 2026

Understanding the economic and healthcare burden of metabolic dysfunction-associated steatohepatitis: a real-world claims data analysis from Germany

Authors: Frank Tacke https://orcid.org/0000-0001-6206-0226, Yestle Kim, Jennifer S Haas https://orcid.org/0000-0001-7872-2060 [email protected], Melinda J Daumont, Christopher Maas, John O'Donnell, and Jörn M Schattenberg https://orcid.org/0000-0002-4224-4703Author Info & Affiliations
Volume 15, Number 8
https://doi.org/10.57264/cer-2026-0092
PDFFormats

Abstract

Aim: Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive form of metabolic dysfunction-associated steatotic liver disease, linked to hepatic and extra-hepatic complications and substantial healthcare costs. Despite its clinical and economic impact, real-world evidence on disease progression and costs in Germany is limited. Materials & methods: We conducted a retrospective cohort study using statutory health insurance claims from the InGef database (2016–2023), covering 4.7% of the German population. Patients with MASH were identified using ICD-10-GM code K75.8, in absence of the more specific code in the German coding system. Baseline characteristics and comorbidities were assessed over 2 years prior to index diagnosis. Progression was defined by transitions through end-stage liver disease (ESLD) stages: compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma and liver transplantation. Healthcare costs were analyzed descriptively and via regression models. Results: Among 4710 patients with MASH (prevalence: 0.15%), 39.4% had documented ESLD during follow-up (mean follow-up in days 1530). Disease progression to ESLD occurred in 26.0% of patients without baseline ESLD (n = 922/3490), whereas 4.0% of patients with baseline ESLD (n = 48/1188) progressed to a more severe ESLD stage during follow-up, with a mean time to first progression of approximately 25.3 months. Patients with ESLD incurred annual costs of €12,737 versus €4928 for those without ESLD. Progression to hepatocellular carcinoma and liver transplantation resulted in predicted costs of €12,948 and €75,719 per patient-year, respectively. Mortality was significantly higher among patients with ESLD (incidence rate ratio: 4.65; 95% CI: 3.76–5.79). Discussion: Over a quarter of identified patients with MASH already had advanced liver disease at baseline, suggesting potential underdiagnosis or late recognition in routine clinical practice. Early detection, proactive management and targeted therapies are essential to reduce progression and economic burden.

Plain language summary: Disease progression, healthcare use & costs in people with MASH in Germany

What is this article about?

This article looks at how metabolic dysfunction-associated steatohepatitis (MASH), a serious form of fatty liver disease, affects people in Germany. Using German health insurance claims data from 2016 to 2023, the study examined how often people with MASH developed advanced liver disease, what other health problems they had, and how much their healthcare cost.

What were the results?

Among 4710 identified patients with MASH, many already had advanced liver disease or developed it during follow-up. Patients with end-stage liver disease had much higher healthcare costs than those without it. Costs increased further in more severe stages such as liver cancer or liver transplantation. Patients with advanced liver disease also had a much higher risk of death and major cardiovascular events.

What do the results mean?

The findings show that MASH places a substantial burden on patients and the healthcare system in Germany, especially when the disease progresses to advanced liver stages. Earlier detection and better management may help reduce complications, improve outcomes and lower costs. The results also suggest that MASH may often be diagnosed late in routine care.

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References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
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