Healthcare costs and treatment patterns associated with glucagon-like peptide 1 receptor agonist use among patients with metabolic dysfunction-associated steatohepatitis
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: While only recently approved for the treatment of metabolic dysfunction-associated steatohepatitis (MASH), many patients with MASH have taken glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for the treatment of comorbid Type 2 diabetes (T2D) or obesity. This real-world study evaluated treatment patterns, weight loss, healthcare resource utilization, and costs among patients with MASH who initiated GLP-1 RAs. Materials & methods: In a linked electronic health records (Veradigm Network EHR) and claims (Komodo Health) dataset, we identified adults (≥18 years old) with a MASH diagnosis who initiated GLP-1 RA treatment (1 July 2018 to 30 April 2023; index date = date of the first GLP-1 RA claim). Patients with other causes of liver disease or severe complications from MASH were excluded. We required ≥12 months of continuous enrollment pre- (baseline) and post-index (follow-up). Patients were stratified into high and low-dose subgroups. We also identified a comparator cohort of patients who initiated a different class of T2D medication (DPP4, SGLT2, or sulfonylurea) during the same time period. We captured patient characteristics, change in BMI, GLP-1 RA treatment patterns, liver-related events, healthcare utilization, and costs. Results: We identified 10,316 patients with MASH who initiated a GLP-1 RA (high dose: 2043 [19.8%]; low dose: 8273 [80.2%]) and 2915 who initiated a non-GLP-1 RA T2D medication. GLP-1 RA users were 52.7 years old and 64.3% female. A 5.8% decrease in the percentage of patients with class III obesity was observed among GLP-1 RA users (10.7% among high-dose users; 0.8% among non-users). Overall, 56.1% of GLP-1 RA users discontinued during the 12-month follow-up. Total costs among GLP-1 RA users and non users were $20,912 and $19,019 in the baseline period and $27,586 and $24,917 in the follow-up period, respectively. Medical costs among GLP-1 RA users were $16,293 (baseline) and $16,886 (follow-up). Results were similar for high and low-dose subgroups. Conclusion: Although some patients with MASH on GLP-1 RAs, particularly those taking higher dosages, may achieve weight loss, outcomes remain suboptimal with frequent discontinuation and high healthcare costs. Real-world GLP-1 RA utilization may be insufficient for resolving chronic metabolic issues, including MASH.
Plain language summary: An analysis of costs and medication usage among people with metabolic dysfunction-associated steatohepatitis who were prescribed glucagon-like peptide-1 receptor agonists
What is this article about?
Metabolic dysfunction-associated steatohepatitis (MASH) is a liver disease that gets worse over time. MASH can lead to serious complications such as liver failure. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are used to treat obesity and Type 2 diabetes, which are common among people with MASH. This article is about the usage of GLP-1 RAs among people diagnosed with MASH. We looked at patient characteristics, BMI, patterns of medication treatment, reasons for discontinuation and changes in healthcare use and costs after starting GLP-1 RA. We also captured similar data for people who started a different Type 2 diabetes treatment to provide additional context.
What were the results?
People with MASH who took GLP-1 RA tended to lose weight, measured as a decrease in the percentage of patients with a very high BMI (≥40). This was not observed in people who started a different Type 2 diabetes treatment. More than half of people who started GLP-1 RAs stopped treatment for at least 45 days within 1 year. Roughly half of people who stopped treatment did not restart treatment. Side effects were the most common reason for stopping treatment. Total healthcare costs were $27,586, and nonmedicine-related costs were $16,886 in the year after starting treatment.
What do the results mean?
GLP-1 RA may be effective in promoting weight loss among people with MASH, but these medications may not address other issues among people with MASH as healthcare use and costs remain high.
Supplementary Material
References
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© 2025 Madrigal Pharmaceuticals, Inc. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
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Received: 23 November 2024
Accepted: 28 August 2025
Published online: 6 October 2025
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Healthcare costs and treatment patterns associated with glucagon-like peptide 1 receptor agonist use among patients with metabolic dysfunction-associated steatohepatitis. (2025) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2024-0223
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