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Health-care burden of metabolic dysfunction-associated steatotic liver disease in European tertiary-care outpatient clinics (CONSTANS): a prospective multicentre cohort study -
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The Lancet Regional Health - Europe
even in specialized clinical practice, the implementation of a truly holistic management of MASLD patients' needs further optimization.
MASLD is now the second most common cause for outpatient visits in hepatology centers in seven European countries.
Although mostly asymptomatic, advanced fibrosis was present in around a third of patients while one out of ten having cryptogenic cirrhosis attributable to advanced (burnt-out) MASLD. This generated substantial medical investigations whose overall cost equaled that of the exploration of chronic hepatitis C. The use of non-invasive tests was still suboptimal and a multidisciplinary care insufficiently implemented.
Summary
Background
Despite modeling-based epidemiological studies of MASLD, precise estimates of the prevalence and health-care resource utilization in outpatient clinical practice are unknown. We assessed, in a real-life setting, the prevalence of suspected/confirmed MASLD and described health-care resource utilization.
Methods
A prospective, observational study of patients attending the outpatient hepato-gastroenterology clinics of eight European tertiary care centers during three months. Follow-up data of patients with suspected/confirmed MASLD were recorded 12 months after the screening visit: final diagnosis, disease stage, diagnostic work-up and the use of health-care resources.
Findings
5240 outpatients from Germany, France, United Kingdom, Switzerland, Italy, Spain and Slovakia were screened. The main reasons for visit were: chronic viral hepatitis, 33.4% (1749/5240), miscellaneous hepatobiliary conditions including neoplasms, 32.9% (1725/5240) and known/suspected MASLD, 24.7% (1293/5240) (pooled prevalence of 26.1% (95% CI: 19.1-34.7)). 1134 suspected/confirmed MASLD patients were included, the diagnosis was confirmed in 80.2% (909/1134).
Significant fibrosis was documented in 22.7% (257/1134) and cirrhosis (including burn-out MASLD) in 21.3% (241/1134).
Procedures performed differed between countries, overall 66.4% (753/1134) had imaging studies, 65.3% (740/1134) non-invasive fibrosis tests, 20.4% (231/1134) liver biopsy, while referral for further cardiometabolic assessment or therapy was minimal (144/1134, 15.8%).
The cost of all procedures and visits was in the range of that recommended for exploring hepatitis C before treatment, although highly variable between countries.
Interpretation
MASLD was the second most frequent single cause for outpatient visits in eight European tertiary care centers. Significant fibrosis including cirrhosis was diagnosed in 44% of patients. The cost of required additional visits and procedures was equivalent to that recommended for hepatitis C before antiviral treatment.
https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(26)00305-4/fulltext
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