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

Direct medical costs for metabolic dysfunction–associated steatohepatitis (MASH) complicated by type 2 diabetes (T2D) are on track to rise nearly 5-fold in the US by 2040 simply because the disease itself largely goes unmanaged, explained Zobair M. Younossi, MD, chairman of The Global NASH/MASH Council.

Despite the availability of approved therapies, risk stratification rates remain low in the primary care and endocrinology settings where most patients with MASH and T2D are seen. Without stratification, patients don't enter treatment pathways, and the disease, along with its costly complications, continues to progress unchecked.

What's Actually Driving the Cost Surge

Younossi stressed that medication costs represent only a small fraction of overall spending. The dominant drivers are the disease complications themselves: cirrhosis, decompensated liver disease, liver transplantation, and premature death. In the US, indirect costs tied to lost work productivity compound the problem further, pushing the total economic burden well above that seen in other countries modeled in the analysis.

"The cost is primarily related to the disease itself and all the complications of the disease, rather than just medication, because the medication cost is really a small proportion of the driver of the cost," Younossi said.

The root cause, he explained, is that obesity and T2D continue on an upward trajectory, fueling MASH diagnoses and downstream complications at a rate that outpaces the current capacity to identify and treat eligible patients.

Why Broader Treatment Access Could Bend the Cost Curve

Counterintuitively, expanding access to MASH therapies and identifying more patients for treatment may ultimately lower the overall cost burden. Younossi argued that savings generated by preventing cirrhosis and its complications down the line would offset the added upfront costs of drug therapy and diagnostic testing.

He also pointed to market dynamics: as awareness grows and more patients are identified, additional drug developers will enter the space, which will increase competition and drive prices down over time.

"I'm actually a believer that identifying patients, raising awareness, ultimately will bring in more and more competitors into the field and will be more options for patients, and the overall burden—if you can make a dent—actually could be lower than what we have," Younossi said.

The findings underscore a familiar tension: underdiagnosis today may produce far higher costs tomorrow, making investment in earlier identification and treatment access a potential long-term savings strategy for payers and health systems alike.