Department of Gastroenterology and Hepatology, Henry Ford Hospital, Wayne State University School of Medicine, Detroit, Michigan, USA.
Gilead Sciences, Health Economics Outcomes Research, Foster City, California, USA.
Am J Gastroenterol. 2020 Apr;115(4):562-574. doi: 10.14309/ajg.0000000000000484.
As the prevalence of nonalcoholic steatohepatitis (NASH) in the elderly population increases, healthcare resource utilization (HCRU) and costs are also predicted to rise substantially.
This retrospective, observational cohort study used the Medicare 20% sample data set to evaluate the impact of NASH severity on HCRU and costs over 8 years (2007-2015). The sample included 255,681 patients with nonalcoholic fatty liver disease (NAFLD)/NASH: 185,407 (72.5%) with NAFLD/NASH and no further progression to advanced liver disease, 3,454 (1.3%) with compensated cirrhosis (CC), 65,926 (25.8%) with decompensated cirrhosis (DCC), 473 (0.2%) with liver transplant (LT), and 421 (0.2%) with hepatocellular carcinoma (HCC).
Rates of comorbid diabetes, hypertension, hyperlipidemia, and cardiovascular disease were significantly higher in patients with CC or more severe liver disease compared with NAFLD/NASH and no progression. The annual mean number of all-cause healthcare visits increased from 32.1 for NAFLD/NASH with no progression to 37.3 for CC, 59.8 for DCC, 74.1 for LT, and 59.3 for HCC (P < 0.05). Total annual costs for inpatient, outpatient, physician, and pharmacy services rose from $19,908 in NAFLD/NASH with no progression to $129,276 for LT (P < 0.05). Generalized linear model adjusted for patient characteristics and comorbidities revealed that costs were 1.19, 3.15, 5.02, and 3.33 times significantly higher in patients diagnosed with CC, DCC, LT, or HCC, respectively, compared with NAFLD/NASH and no progression.
These results confirm the substantial impact of NASH, particularly more severe disease, on HCRU and costs and identify patients who may benefit from interventions to prevent progression and subsequently reduce HCRU and costs.
随着非酒精性脂肪性肝炎（NASH）在老年人群中的患病率增加，预计医疗保健资源利用（HCRU）和成本也将大幅上升。
本回顾性观察性队列研究使用 Medicare 20%抽样数据集评估了 NASH 严重程度对 8 年内（2007-2015 年）HCRU 和成本的影响。该样本包括 255681 名非酒精性脂肪性肝病（NAFLD）/NASH 患者：185407 名（72.5%）无进一步进展为晚期肝病的患者，3454 名（1.3%）代偿性肝硬化（CC）患者，65926 名（25.8%）失代偿性肝硬化（DCC）患者，473 名（0.2%）肝移植（LT）患者和 421 名（0.2%）肝细胞癌（HCC）患者。
与 NAFLD/NASH 且无进展相比，CC 或更严重肝病患者的合并症糖尿病、高血压、高脂血症和心血管疾病的发生率明显更高。所有原因的医疗就诊次数的年平均值从无进展的 NAFLD/NASH 的 32.1 次增加到 CC 的 37.3 次、DCC 的 59.8 次、LT 的 74.1 次和 HCC 的 59.3 次（P <0.05）。住院、门诊、医生和药房服务的年总费用从无进展的 NAFLD/NASH 的 19908 美元增加到 LT 的 129276 美元（P <0.05）。对患者特征和合并症进行广义线性模型调整后发现，与 NAFLD/NASH 且无进展相比，分别诊断为 CC、DCC、LT 或 HCC 的患者的费用分别显著高出 1.19、3.15、5.02 和 3.33 倍。
这些结果证实了 NASH，特别是更严重疾病，对 HCRU 和成本的重大影响，并确定了可能从预防疾病进展进而降低 HCRU 和成本的干预措施中获益的患者。
