The Financial and Clinical Cost of Delayed MASH Detection and Fragmented Care

Dr. Jaideep Behari highlighted the systemic financial and clinical consequences of delayed MASH detection, emphasizing that the liver plays a central role in cardiorenal metabolic (CKM) syndrome — which he proposed reframing as CKLM syndrome to reflect the liver's contribution — and that progressive liver fibrosis is strongly associated with the development of type 2 diabetes, chronic kidney disease (CKD), and cardiovascular disease, with end-stage disease potentially requiring liver transplantation. Dr. Behari outlined the clinical and economic value of early detection and risk stratification, noting that two conditionally approved therapies are currently available for metabolic dysfunction-associated steatotic liver disease (MASLD) and MASH that can reduce progression to advanced liver disease, and that glucagon-like peptide-1 (GLP-1) receptor agonists offer cost-effective multi-target treatment for patients with overlapping metabolic comorbidities. He then addressed the impact of care fragmentation, explaining that patients with MASH are frequently seen by multiple specialists — including nephrologists, cardiologists, and hepatologists — who are increasingly drawing on the same therapeutic options, including GLP-1 receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors, making integrated, metabolic medicine-focused care delivery essential. Finally, Dr. Behari underscored the population health challenge posed by low awareness of MASH risk stratification algorithms among primary care providers and subspecialists, noting that in his own clinic, 65% of referred patients over the last 5 years were low risk and did not require subspecialty care, pointing to the urgent need for right-sizing referrals through system-wide implementation of standardized care pathways.

Throughout the conversation, the expert provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

In the next episode, 'System-Level Barriers and Evidence Gaps in the Adoption of Emerging MASH Therapies,' the panelist continues their discussion on metabolic dysfunction-associated steatohepatitis and highlight the key obstacles to adopting emerging MASH therapies at the system level, the role of risk stratification tools such as the Fibrosis 4 (FIB-4) Index in guiding referral decisions, and the clinical and economic evidence still needed to support formulary adoption of new