Increasing healthcare resource utilization (HCRU) and costs associated with advanced liver disease-a multivariate analyses of real-world medicare nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/ NASH) patients.

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Background: HCRU and costs significantly increase among NAFLD/NASH patients who progress to compensated cirrhosis (CC). However, data on HCRU and costs associated with progression from CC to end stage liver disease (ESLD) are limited. This study evaluated the incremental increases in HCRU and costs associated with progression to ELSD among NAFLD/NASH CC patients. Methods: This was a retrospective study from 2007-2015 of a 20% random sample of US Medicare beneficiaries and included NAFLD/NASH patients (ICD-9/10-CM codes) aged ≥18 years. This study identified cohorts of CC, decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), and liver transplant (LT) patients. ESLD was defined as the presence of DCC, HCC, or LT. Index date was defined as the earliest diagnosis (dx) date for each stage. Patients were followed from index date to earliest of 6 months, progression to different stage, death, end of coverage, or 12/31/2015. Annual costs were reported in 2015 USD. Generalized linear models were used to adjust for patients' baseline demographics and comorbidities. Results: Among 260,950 NAFLD/NASH patients (60% female), 3,454 (1.3%) had CC, and 25.6% had ESLD including 65,962 (25.3%) DCC, 421 (0.2%) HCC, and 473 (0.2%) LT. Mean ages for DCC (70.5) and HCC (72.5) were higher than CC (66.7) patients (both p<0.001). Comorbidity burden was high, with at least 58% of CC and ESLD patients having all 3 conditions of diabetes, hypertension, and hyperlipidemia. Mean annual number of hospitalizations was 0.7 in CC patients and lower than DCC (2.0), HCC (1.7), and LT (3.1), p<0.001 for all. Similar significant trends were seen in physician visits and prescription fills. Annual costs were high and significantly increased with disease progression, driven primarily by higher inpatient costs (Figure). DCC had $74,454, HCC had $68,420, and LT had $129,276 in costs, higher than CC costs of $26,538, p<0.001 (censoring at progression). After multivariate adjustment, healthcare costs were 264%, 271%, and 420% significantly higher for DCC, HCC, and LT than CC patients, respectively. Conclusion: Following disease progression from CC to ESLD, NAFLD/ NASH patients experienced a significant increase in HCRU and at least 250% higher costs, primarily driven by inpatient costs. Halting or reversing fibrosis to prevent progression to ESLD in NAFLD/NASH CC patients may decrease HCRU and associated costs. (Figure Presented).



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