巴西代谢功能障碍相关脂肪性肝炎的临床和经济负担预测：对2型糖尿病患者的20年预测

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-09-01 DOI:10.1016/j.aohep.2025.102035

Zobair Younossi , James M. Paik , Cristiane A. Villela-Nogueira , Claudia Pinto Oliveira , Fatema Nader , Linda Henry , Mário Guimarães Pessoa

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引用次数: 0

摘要

2型糖尿病（T2D）是代谢功能障碍相关脂肪性肝炎（MASH）及其并发症的重要危险因素。探讨T2D状况对成人MASH经济负担的长期影响。smarkov模型模拟了巴西20年（2021-2040年）MASH患者的自然病史。对转移概率进行校准，以与巴西肝硬化、肝细胞癌（HCC）、肝移植（LT）、肥胖和T2D的国家数据保持一致。该模型纳入了相互竞争的死亡率风险（肝脏相关、心血管和其他原因）。直接医疗费用（门诊、诊断、住院、手术、药物）的基线估计采用国家来源，包括Fiocruz观测站数据库和巴西卫生系统概况，按疾病分期估计。成本以2020年美元计算，并根据国际货币基金组织的通胀预测进行调整。结果从2021年到2040年，巴西成人MASH患病率预计将从7.19%上升到7.52%。在一般人群中，mash相关性肝硬化的患病率将从0.63%增加到0.99%，而mash相关性HCC、-LT和-肝死亡将从每10万人0.50增加到1.02、0.17增加到0.38和10.08增加到13.46。MASH合并T2D的比例将从25.3%增加到30.8%。在mash -肝硬化患者中，这一比例将从23.9%增加到27.8%。每年与mash相关的直接医疗费用将由2021年的34.1亿元上升至2040年的98.1亿元，其中T2D占比将由30.7%上升至40.1%（图）。结论巴西MASH的临床和经济负担将随着T2D的增加而增加。

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PROJECTED CLINICAL AND ECONOMIC BURDEN OF METABOLIC DYSFUNCTION–ASSOCIATED STEATOHEPATITIS IN BRAZIL: A 20-YEAR FORECAST ACROSS TYPE 2 DIABETES STATUS

Introduction and Objectives

Type 2 diabetes (T2D) is an important risk factor for metabolic dysfunction–associated steatohepatitis (MASH) and its complications.

Explore long-term impact economic burden of MASH among adults by T2D status.

Patients and Methods

Markov model simulated the natural history of patients with MASH in Brazil over a 20-year horizon (2021–2040). Transition probabilities were calibrated to align with Brazil’s national data for cirrhosis, hepatocellular carcinoma (HCC), liver transplantation (LT), obesity, and T2D. The model incorporated competing mortality risks (liver-related, cardiovascular, and other causes). Baseline estimates of direct medical costs (outpatient care, diagnostics, hospitalizations, procedures, medications) were estimated by disease stage using national sources, including the Fiocruz Observatory database and Brazil’s health system profile. Costs are reported in 2020 USD, adjusted using IMF inflation projections.

Results

From 2021 to 2040, MASH prevalence among adults in Brazil is projected to rise from 7.19% to 7.52%. In the general population, the prevalence of MASH-related cirrhosis will increase from 0.63% to 0.99%, while MASH-related HCC, -LT and -liver deaths will increase from 0.50 to 1.02, 0.17 to 0.38 and 10.08 to 13.46 per 100,000. The proportion of MASH cases with T2D will increase from 25.3% to 30.8%. Among MASH-cirrhosis patients, this proportion will increase from 23.9% to 27.8%. Annual MASH-related direct medical costs will rise from $3.41 billion in 2021 to $9.81 billion by 2040, with the proportion attributable to T2D increasing from 30.7% to 40.1% (Figure).

Conclusions

Clinical and economic burden of MASH in Brazil is expected to rise with increasing share attributable to T2D.

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来源期刊

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.