Boursier Jérôme, Shreay Sanatan, Fabron Cecile, Torreton Elodie, Fraysse Jeremy
Laboratoire HIFIH UPRES EA3859, SFR 4208, Université d'Angers, Angers, France.
Service d'Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d'Angers, Angers, France.
EClinicalMedicine. 2020 Aug 3;25:100445. doi: 10.1016/j.eclinm.2020.100445. eCollection 2020 Aug.
Nonalcoholic fatty liver disease (NAFLD) has reached high prevalence, paralleling the obesity pandemic. The aggressive form of the disease, nonalcoholic steatohepatitis (NASH), is characterized by fatty infiltration and inflammation of the liver, can progress to compensated cirrhosis (CC) and end-stage liver disease (ESLD: decompensated cirrhosis [DCC] and hepatocellular carcinoma [HCC]), and may ultimately require liver transplantation (LT). Real-world data on the burden of NAFLD/NASH are limited. This study aimed to evaluate the clinical and economic burden of NAFLD/NASH to the French hospital system.
This retrospective cohort study used data from the French PMSI-MCO database. Adults with NAFLD/NASH diagnosis identified between 2009 and 2015 were categorized into disease severity cohorts (NAFLD/NASH, CC, DCC, HCC, and LT). Demographic and clinical data were assessed at the index (diagnosis) date. Hospitalization resource utilization and costs were assessed in the pre- and post-index periods. Rates of liver disease progression and death were evaluated for each cohort.
During the median follow-up of 34.8 months, of the 131,656 patients included, 1491 patients developed CC (1.1%), 7846 developed DCC (5.9%), 1144 developed HCC (0.9%), and 52 required LT (0.04%). The diagnosis of NAFLD/NASH was associated with increasing annual costs: €7736 vs €5076 before the diagnosis. Rates of comorbidities, hospitalization resource utilization, and costs increased with disease progression. The rate of death at seven-year follow-up was 7.9% in NAFLD/NASH, CC: 18.0%, DCC: 34.9%, and HCC: 48.8%.
NAFLD/NASH is associated with high economic burden and imparts substantial risk of negative clinical outcomes and mortality at all stages of disease.
非酒精性脂肪性肝病（NAFLD）的患病率已达到很高水平，与肥胖症的流行情况相当。该疾病的侵袭性形式，即非酒精性脂肪性肝炎（NASH），其特征为肝脏脂肪浸润和炎症，可进展为代偿性肝硬化（CC）和终末期肝病（ESLD：失代偿性肝硬化[DCC]和肝细胞癌[HCC]），最终可能需要肝移植（LT）。关于NAFLD/NASH负担的真实世界数据有限。本研究旨在评估NAFLD/NASH对法国医院系统造成的临床和经济负担。
这项回顾性队列研究使用了来自法国PMSI-MCO数据库的数据。2009年至2015年间确诊为NAFLD/NASH的成年人被分为疾病严重程度队列（NAFLD/NASH、CC、DCC、HCC和LT）。在索引（诊断）日期评估人口统计学和临床数据。在索引前和索引后时期评估住院资源利用情况和费用。评估每个队列中肝病进展率和死亡率。
在34.8个月的中位随访期间，纳入的131,656例患者中，1491例发展为CC（1.1%），7846例发展为DCC（5.9%），114例发展为HCC（0.9%），52例需要LT（0.04%）。NAFLD/NASH的诊断与年度费用增加相关：诊断前为5076欧元，诊断后为7736欧元。合并症发生率、住院资源利用情况和费用随着疾病进展而增加。在七年随访时，NAFLD/NASH的死亡率为7.9%，CC为18.0%，DCC为34.9%，HCC为48.8%。
NAFLD/NASH与高经济负担相关，并且在疾病的各个阶段都带来了负面临床结局和死亡的重大风险。
