Rising and higher healthcare resource utilization (HCRU) and costs of nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) patients with advanced liver disease of increasing severity-results of a US real-world analysis.

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Background: NAFLD/NASH may progress to advanced liver diseases (ALD) that includes compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC) and liver transplant (LT). The study objective was to characterize the comorbidities, HCRU and associated costs among NAFLD/NASH patients with ALD. Methods: NAFLD/NASH patients aged ≥18 years from 2006-2016 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 CC, DCC, HCC or LT was identified using their 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: This study identified 468,017 NAFLD/NASH commercial patients. Overall, 1.6% (7,665) had CC, 3.4% (15,833) had DCC, 0.09% (428) had HCC, and 0.1% (696) had LT. The comorbidity burden was high across all ALD cohorts-hypertension (36%-50%), hyperlipidemia (36%-45%), abdominal pain (34%-57%), type 2-diabetes (21%-42%). Allcause inpatient (IP) admissions and outpatient (OP) services were significantly higher for NAFLD/NASH patients with ALD than those without ALD (p<0.001), with more than 50% of DCC and LT patients requiring IP admissions post diagnosis of liverstage. 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]. The largest contributor of the total healthcare costs among CC and HCC were OP services; and among DCC and LT were IP admissions. Similar trends were observed among the Medicare supplement database across all ALD cohorts. Conclusion: Among a large cohort of commercially insured NAFLD/NASH patients in the US, progression to ALD was associated with more than 150% higher costs than NAFLD/NASH who did not progress to ALD. Early identification and effective management among NAFLD/ NASH patients are needed to reduce the risk of disease progression and subsequent healthcare costs. (Figure Presented).



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