Real-world Comorbidity Burden, Health Care Utilization, and Costs of Nonalcoholic Steatohepatitis Patients With Advanced Liver Diseases

Abstract

Goals: This study evaluates the real-world comorbidity burden, health care resource utilization (HRU), and costs among nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) patients with advanced liver diseases [compensated cirrhosis (CC), decompensated cirrhosis (DCC), liver transplantation (LT), hepatocellular carcinoma (HCC)].

Background: NAFLD/NASH is a leading cause of liver diseases.

Materials and methods: Adult NAFLD/NASH patients were identified retrospectively from MarketScan Commercial claims (2006-2016). Following initial NAFLD/NASH diagnosis, advanced liver diseases were identified using the first diagnosis as their index date. Mean annual all-cause HRU and costs (2016 USD) were reported. Adjusted costs were estimated through generalized linear models. Cumulative costs were illustrated for patient subsets with variable follow-up for each stage.

Results: Within the database, 485,774 NAFLD/NASH patients met eligibility criteria. Of these, 93.4% (453,564) were NAFLD/NASH patients without advanced liver diseases, 1.6% (7665) with CC, 3.3% (15,833) with DCC, 0.1% (696) with LT, and 0.1% (428) with HCC. Comorbidity burden was high and increased as patients progressed through liver disease severity stages. Compared with NAFLD/NASH without advanced liver diseases (adjusted costs: $23,860), the annual cost of CC, DCC, LT, and HCC were 1.22, 5.64, 8.27, and 4.09 times higher [adjusted costs: $29,078, $134,448, $197,392, and $97,563 (P<0.0001)]. Inpatient admissions significantly drove increasing HRU.

Conclusion: Study findings suggest the need for early identification and effective management of NAFLD/NASH patients to minimize comorbidity burden, HRU, and costs in the privately insured US population.

FIGURE 1

Patient selection. *Liver disease severity stages are non-mutually exclusive since a patient can index on NAFLD/NASH and then be classified under multiple severity stages (CC, DCC, LT, and/or LT). Accordingly, patients are counted in>1 severity stage. AdvLD indicates advanced liver diseases; CC, compensated cirrhosis; DCC, decompensated cirrhosis; HCC, hepatocellular carcinoma; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification; LT, liver transplantation; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis.

FIGURE 2

Annual all-cause health care costs among patients with NAFLD/NASH by liver disease severity stage. ^aNAFLD/NASH study cohort comprises overall NAFLD/NASH patients until progression to a more severe stage, at which follow-up is censored. *P<0.05 for comparison of preindex versus postindex period. †P<0.05 for comparison of CC, DCC, LT, or HCC cohort versus NAFLD/NASH without AdvLD cohort (postindex). ‡P<0.05 for comparison of DCC, LT, or HCC cohort versus CC cohort (postindex). AdvLD indicates advanced liver diseases; CC, compensated cirrhosis; DCC, decompensated cirrhosis; HCC, hepatocellular carcinoma; LT, liver transplantation; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis.

FIGURE 3

Adjusted annual all-cause health care costs from generalized linear model among patients with NAFLD/NASH by liver disease severity stage. ^aNAFLD/NASH study cohort comprises overall NAFLD/NASH patients until progression to a more severe stage, at which follow-up is censored. ^bHealth care costs represent the total annual all-cause postindex costs. †P<0.0001 for comparison of CC, DCC, LT, or HCC cohort versus NAFLD/NASH without AdvLD cohort. AdvLD indicates advanced liver diseases; CC, compensated cirrhosis; DCC, decompensated cirrhosis; HCC, hepatocellular carcinoma; LT, liver transplantation; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis.

FIGURE 4

Cumulative all-cause health care costs among patients with NAFLD/NASH by liver disease severity stage. ^aNAFLD/NASH study cohort comprises overall NAFLD/NASH patients until progression to a more severe stage, at which follow-up is censored. *Percent change denotes the increase in mean costs from year −2 to year 5. †Percent change denotes the increase in mean costs from year −1 to year 1. AdvLD indicates advanced liver diseases; CC, compensated cirrhosis; DCC, decompensated cirrhosis; HCC, hepatocellular carcinoma; LT, liver transplantation; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis.