Fibrosis-4 score (FIB-4) provides consistent assessment of healthcare costs and healthcare resource utilization (HCRU) among Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis (NAFLD/NASH) patients with advanced fibrosis.

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Objectives: To characterize total healthcare costs/HCRU among NAFLD/NASH patients with F3/F4 using FIB-4 index. Methods: NAFLD/NASH patients ≥18 years were identified (ICD- 9/10-CM codes) from 2008 to 2016 using Optum Database. Patients with no history of cirrhosis or hepatocellular carcinoma or liver transplant, having AST, ALT and platelet results within 180 days of each other were identified to calculate their FIB-4. A comprehensive FIB-4 based F3/F4 identification algorithm with 3 separate criteria was developed-(Criteria 1 [C1], Criteria 2 [C2], Criteria 3 [C3]. (Table) The first encounter of C1, C2 and C3 were assigned as F3/F4 index dates. Mean annual total healthcare costs/HCRU was calculated through per member per month values in 2016 USD. Results: Among 91,122 NAFLD/NASH patients with FIB-4 scores, 3251 (3.6%) had F3/F4 based on C1. When using C2, 2482 (2.7%) had F3 and 939 (1.0%) had F4, and when using C3, 363 (0.4%) had F3 and 1463 (1.6%) had F4. The mean age (56-58 years) and sex distribution (45-48% females) were comparable between criteria. A high comorbidity burden was similar across all cohorts-hypertension (57-59%), hyperlipidemia (50-54%), type-2 diabetes (35-37%). Total healthcare costs increased significantly from pre-index to postindex periods for all criteria (Table). The annual mean number of ambulatory visits for F3/F4, F3, and F4 using all criteria indicated a 26%, 21-26% and 29-34% significant increase. Conclusions: NAFLD/NASH patients experienced an increase in healthcare costs (11-48%) post-development of advanced fibrosis. FIB-4 may be a useful tool in assessing economic and clinical burden in NASH/NAFLD patients. (Figure Presented)




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