Untreated MASH With T2D to Drive Costs 5-Fold: Zobair Younossi, MD

Why It Matters

Underdiagnosis of MASH in diabetic patients threatens exponential cost growth, making early risk stratification a strategic priority for insurers and health systems.

Key Takeaways

• MASH with T2D costs could rise five‑fold by 2040.
• Low risk stratification keeps most patients untreated in primary care.
• Complications, not drugs, drive the majority of future spending.
• Early identification may offset drug costs through avoided liver complications.
• Increased patient awareness could spur competition and lower therapy prices.

Pulse Analysis

The convergence of obesity, type 2 diabetes, and metabolic dysfunction‑associated steatohepatitis (MASH) is reshaping the U.S. liver disease landscape. While MASH prevalence has climbed alongside diabetes rates, the condition remains largely invisible in routine primary‑care and endocrinology visits. Without systematic risk stratification—often reliant on non‑invasive imaging or biomarker panels—clinicians miss the window to intervene before fibrosis progresses. This diagnostic gap fuels a silent epidemic that threatens to outpace current therapeutic capacity.

Economic analyses reveal that the lion’s share of MASH‑related expenditures will arise from advanced liver complications rather than drug costs. Cirrhosis, decompensated disease, and liver transplantation demand intensive inpatient care, while premature mortality erodes workforce productivity. Indirect costs, such as lost workdays and disability, further amplify the financial strain. For payers, the looming five‑fold cost surge underscores the urgency of reallocating resources toward early detection programs, which can be more cost‑effective than treating end‑stage disease.

Policy makers and health system leaders are therefore incentivized to broaden access to approved MASH therapies and invest in robust screening pathways. By identifying patients earlier, the healthcare system can avert costly complications, creating a net savings that outweighs the upfront expense of drugs and diagnostics. Moreover, a larger treated population can attract additional pharmaceutical entrants, fostering competition that may drive down drug prices over time. In this context, strategic investment in risk stratification and early treatment emerges as a pragmatic lever to temper the projected cost explosion and improve outcomes for millions of Americans living with diabetes and liver disease.