More than 4 times higher healthcare costs for end-stage liver disease patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis
Gordon SC, Kachru N, Sanatan S, Martinez D, Moynihan M, and Wong R. More than 4 times higher healthcare costs for end-stage liver disease patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. J Hepatol 2019; 70(1):e295-e296.
Background and aims: NAFLD/NASH patients who progress to advanced liver disease (AdvLD) [compensated cirrhosis (CC)/decompensated cirrhosis (DCC)/liver transplant (LT)/hepatocellular carcinoma (HCC)], have significantly higher healthcare resource utilization and costs as compared to NAFLD/NASH patients who do not progress. However, previous studies have not comprehensively adjusted for baseline patient and disease characteristics. This study evaluated adjusted costs associated with progression among NAFLD/NASH patients using a large generalizable US claims database. Method: NAFLD/NASH patients aged ≥ 18 years from 2006-2016 were identified retrospectively from the IBM Watson Health MarketScan¯ Commercial healthcare claims database using ICD-9/10-CM codes. Following the initial NAFLD/NASH diagnosis, development of CC, DCC, LT or HCC was identified using their first diagnosis date for each severity stage (index date). Annual healthcare costs for each liver severity stage were obtained from per patient per month estimates, adjusted for baseline demographics and comorbidities through generalized linear models. Results: Of the total 153, 323, 509 individuals in the database, 468, 017 NAFLD/NASH patients who met inclusion/exclusion criteria were identified. Among this NAFLD/NASH cohort, 96.9% (453, 564) were without AdvLD, 1.6% (7, 665) had CC, 3.4% (15, 833) had DCC, 0.1% (696) had LT and 0.1% (428) had HCC. Patients across all liver stages had a mean age of 48-52 years and >50% females. The comorbidity burden was high across all liver stages with more than 57% patients having ≥ 1 co-morbidity, including hypertension, hyperlipidemia, cardiovascular disease, type-2 diabetes (T2DM) and renal impairment. The adjusted annual healthcare costs increased significantly as patients progressed through liver severity stages. As compared to NAFLD/NASH without AdvLD (adjusted costs: $23, 860), the cost of CC, DCC, LT and HCC was 1.22, 5.64, 8.27 and 4.09 times higher respectively, with adjusted costs being $29, 078, $134, 448, $197,392 and $97,563 respectively (p < 0.001)[Figure] [Figure Presented] Conclusion: Amongst a large cohort of commercially insured NAFLD/NASH patients in the US, adjusted healthcare costs for NAFLD/NASH patients who progress to DCC/LT/HCC were 4-8 times higher than in patients who do not progress. Halting or reversing fibrosis to prevent progression to DCC/LT/HCC in CC patients due to NAFLD/NASH is imperative to limit the increasing healthcare costs.