Rising and higher healthcare-resource-utilization (HCRU) and costs of Nonalcoholic Fatty Liver Disease (NAFLD)/ Nonalcoholic Steatohepatitis (NASH) patients with advanced liver disease-a US real-world-analysis.
Wong R, Kachru N, Meyer N, and Gordon S. Rising and higher healthcare-resource-utilization (HCRU) and costs of Nonalcoholic Fatty Liver Disease (NAFLD)/ Nonalcoholic Steatohepatitis (NASH) patients with advanced liver disease-a US real-world-analysis. Hepatol Int 2019; 13(Suppl 1):S187.
Background: NAFLD/NASH may progress to advanced-liver-diseases (ALD): compensated-cirrhosis (CC), decompensated-cirrhosis (DCC), hepatocellular-carcinoma (HCC) and liver-transplant (LT). We characterize the comorbidities, HCRU and costs among NAFLD/ NASH ALD patients. Methods: NAFLD/NASH patients aged ≥18 years from 2006 to 2016 were identified retrospectively from a large US commercial and Medicare healthcare claims database using ICD-9/10-CM codes. Following the initial NAFLD/NASH diagnosis, development of ALD was identified using first diagnosis date for each severity cohort (index date). Eligible patients were followed from index date to earliest of 6 months, progression to different cohort, end of coverage, or end of study period. Within each severity cohort, per member per month values were annualized to calculate the mean annual all-cause HCRU/costs as per 2016 USD. Results: Of 468,017 NAFLD/NASH patients, 1.6% (7665) had CC, 3.4% (15,833) had DCC, 0.09% (428) had HCC, and 0.1% (696) had LT. Comorbidities were high across all ALD cohorts-hypertension (36-50%), hyperlipidemia (36-45%), abdominal pain (34-57%), type 2-diabetes (21-42%). All-cause inpatient (IP) admissions and outpatient (OP) services were significantly higher for NAFLD/NASH patients with ALD than those without ALD (p<0.001), with >50% of DCC and LT patients requiring IP admissions post diagnosis of liver-stage. Mean annual costs post-index among NAFLD/NASH with ALD patients were more than 150% higher compared to NAFLD/NASH without ALD ($35,715 (CC), $181,134 (DCC), $147,401 (HCC), and $300,408 (LT) vs. $22,953 (NAFLD/NASH without ALD) [p<0.001]. Conclusion: Early identification and effective management among NAFLD/NASH patients are needed to reduce the risk of disease progression and subsequent healthcare costs. (Figure Presented)