Diabetes and heart disease triple costs for liver disease patients
A Swedish study of nearly 1,000 patients found that those with metabolic liver disease plus diabetes or cardiovascular disease rack up healthcare costs three times higher than those without these complications. The finding matters to insurers, employers, and health systems planning budgets and intervention strategies for managing multiple chronic conditions.
Originaltitel: Comorbid type 2 diabetes and cardiovascular disease drive higher healthcare costs in MASLD/MASH: a retrospective Swedish cohort study.
Patienter med metabolisk leverstelfingrad sjukdom (MASLD/MASH) och samtidig diabetes typ 2 eller hjärt-kärlsjukdom orsakar betydligt högre sjukvårdskostnader än de utan dessa tillstånd. En retrospektiv kohortstudie från tre svenska universitetssjukhus analyserade 959 patienter med biopsikonfirmerad diagnos mellan 1974 och 2020. Resultaten visar att årskostnaden var cirka 71 procent högre för patienter med diabetes och 76 procent högre för de med hjärt-kärlsjukdom jämfört med motsvarande grupper utan komorbiditet. Båda tillstånden associerades också med mer avancerad fibros vid baseline och högre incidens av cirros eller hepatocellulär karcinom under uppföljning. Karolinska Institutet, Linköpings universitet och Uppsala universitet genomförde studien. Resultaten motiverar multidisciplinär behandling för att minska sjukdomsprogression och kostnadsbelastningen — kritiskt för beslutsfattare inom regional sjukvård som planerar resursallokering.
OBJECTIVES: We compared healthcare resource utilization (HCRU) and healthcare costs in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic dysfunction-associated steatohepatitis (MASH) with or without obesity, type 2 diabetes (T2D) or cardiovascular disease (CVD). METHODS: This cohort study included adults with biopsy-confirmed MASLD/MASH from three Swedish university hospitals (1974-2020). Clinical data were linked to national registers to capture long-term outcomes, HCRU and costs. In addition to the overall cohort, patients were stratified into comorbidity-positive and comorbidity-negative subgroups for obesity, T2D and CVD. HCRU outcomes were hospitalizations, length of stay and outpatient visits. Total costs were the sum of direct costs (hospitalizations, outpatient visits, prescribed drugs) and indirect costs (sickness, early retirement benefits). Negative binomial and generalized linear models were used to estimate adjusted annual HCRU and costs, respectively. RESULTS: Among 959 patients, 40%, 25% and 11% were living with obesity, T2D and CVD, respectively. Patients with T2D or CVD had more advanced fibrosis at baseline and a higher incidence of cirrhosis or hepatocellular carcinoma during follow-up (up to 46 years depending on outcome), compared with those without T2D or CVD. T2D and CVD were linked to substantially greater HCRU and costs: mean annual total costs were approximately 76% higher for CVD and 71% higher for T2D compared with subgroups without these comorbidities. CONCLUSIONS: T2D and CVD are linked to an increased economic burden in MASLD/MASH. Holistic, multidisciplinary management is essential to help mitigate disease progression and the associated clinical and economic burden.