Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
Hepatology. 2018 Dec;68(6):2230-2238. doi: 10.1002/hep.30094. Epub 2018 Sep 20.
The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing. The health care burden resulting from the multidisciplinary management of this complex disease is unknown. We assessed the total health care cost and resource utilization associated with a new NAFLD diagnosis, compared with controls with similar comorbidities. We used OptumLabs Data Warehouse, a large national administrative claims database with longitudinal health data of over 100 million individuals enrolled in private and Medicare Advantage health plans. We identified 152,064 adults with a first claim for NAFLD between 2010 and 2014, of which 108,420 were matched 1:1 by age, sex, metabolic comorbidities, length of follow-up, year of diagnosis, race, geographic region, and insurance type to non-NAFLD contemporary controls from the OptumLabs Data Warehouse database. Median follow-up time was 2.6 (range 1-6.5) years. The final study cohort consisted of 216,840 people with median age 55 (range 18-86) years, 53% female, 78% white. The total annual cost of care per NAFLD patient with private insurance was $7,804 (interquartile range [IQR] $3,068-$18,688) for a new diagnosis and $3,789 (IQR $1,176-$10,539) for long-term management. These costs are significantly higher than the total annual costs of $2,298 (IQR $681-$6,580) per matched control with similar metabolic comorbidities but without NAFLD. The largest increases in health care utilization that may account for the increased costs in NAFLD compared with controls are represented by liver biopsies (relative risk [RR] = 55.00, 95% confidence interval [CI] 24.48-123.59), imaging (RR = 3.95, 95% CI 3.77-4.15), and hospitalizations (RR = 1.87, 95% CI 1.73-2.02). Conclusion: The costs associated with the care for NAFLD independent of its metabolic comorbidities are very high, especially at first diagnosis. Research efforts shouldfocus on identification of underlying determinants of use, sources of excess cost, and development of cost-effective diagnostic tests.
非酒精性脂肪性肝病（NAFLD）的患病率正在上升。由于这种复杂疾病的多学科管理，其带来的医疗保健负担尚不清楚。我们评估了与具有相似合并症的对照者相比，新诊断的 NAFLD 相关的总医疗保健费用和资源利用情况。我们使用了 OptumLabs 数据仓库，这是一个大型的全国性行政索赔数据库，其中包含 1 亿多参加私人和 Medicare Advantage 健康计划的个人的纵向健康数据。我们确定了 2010 年至 2014 年间首次诊断为 NAFLD 的 152064 名成年人，其中 108420 名按年龄、性别、代谢合并症、随访时间、诊断年份、种族、地理区域和保险类型与 OptumLabs 数据仓库数据库中的非 NAFLD 当代对照者进行了 1:1 匹配。中位随访时间为 2.6 年（范围 1-6.5 年）。最终研究队列包括 216840 名中位年龄为 55 岁（范围 18-86 岁）的成年人，其中 53%为女性，78%为白人。私人保险的 NAFLD 新诊断患者的年护理总成本为 7804 美元（四分位距 [IQR] 3068-18688 美元），长期管理成本为 3789 美元（IQR 1176-10539 美元）。这些成本明显高于具有相似代谢合并症但无 NAFLD 的匹配对照者的每年 2298 美元（IQR 681-6580 美元）的总成本。与对照组相比，NAFLD 患者的医疗保健利用率大幅增加，这可能导致其医疗保健费用增加，其中包括肝活检（相对风险 [RR] = 55.00，95%置信区间 [CI] 24.48-123.59）、影像学检查（RR = 3.95，95% CI 3.77-4.15）和住院治疗（RR = 1.87，95% CI 1.73-2.02）。结论：与代谢合并症无关的 NAFLD 护理相关成本非常高，尤其是在初次诊断时。研究工作应集中于确定使用的潜在决定因素、过度成本的来源以及开发具有成本效益的诊断测试。
