Canbay Ali, Kachru Nandita, Haas Jennifer Scarlet, Meise Dominic, Ozbay A Burak, Sowa Jan-Peter
Department of Internal Medicine, Ruhr-University Bochum, Bochum, Germany.
Gilead Sciences, Inc., Health Economics Outcomes Research, Foster City, CA, USA.
Ann Transl Med. 2021 Apr;9(8):615. doi: 10.21037/atm-20-7179.
Patients with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are associated with progression to advanced liver diseases that include compensated cirrhosis, decompensated cirrhosis, liver transplantation, and hepatocellular carcinoma (HCC). This study characterized comorbidities, healthcare resource utilization (HRU), and associated costs among NAFLD patients in Germany.
German healthcare claims data between 2011 and 2016 were analyzed retrospectively. Adult patients diagnosed with NAFLD and/or NASH were categorized as NAFLD, NAFLD non-progressors, compensated cirrhosis, decompensated cirrhosis, liver transplant, or HCC. Within each stage, annual all-cause HRU and costs were measured during the pre- and post-index periods.
Among 4,580,434 patients in the database, proportion of NAFLD was 4.7% (n=215,655). Of them, 36.8% were non-progressors, 0.2% compensated cirrhosis, 9.6% decompensated cirrhosis, 0.0005% liver transplant, and 0.2% HCC. Comorbidity rates were significantly higher in compensated cirrhosis, decompensated cirrhosis, and HCC compared with non-progressors (52.07%, 56.46%, 57.58% 27.49% for cardiovascular disease; 77.13%, 76.61%, 83.47% 54.89% for hypertension; 47.20%, 53.81%, 52.89% 35.21% for hyperlipidemia; 49.88%, 36.67%, 48.21% 20.38% for type 2 diabetes mellitus). The mean annual numbers of post-index outpatient visits and inpatient hospitalizations were significantly higher in patients with advanced liver diseases versus non-progressors. Mean annual costs were significantly higher among patients with advanced liver diseases (compensated cirrhosis, €10,291; decompensated cirrhosis, €22,561; liver transplant, €34,089; HCC, €35,910) than non-progressors (€3,818, P<0.001, except liver transplant cohort). This trend remained consistent after adjusting for baseline demographics and comorbidities.
NAFLD patients in Germany are grossly underdiagnosed and exert substantial healthcare resource use and economic burden, particularly those with advanced liver diseases. Optimal strategies for early identification and management are needed to prevent disease progression and limit the rising costs.
非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）患者与进展为晚期肝病相关，这些晚期肝病包括代偿期肝硬化、失代偿期肝硬化、肝移植和肝细胞癌（HCC）。本研究对德国NAFLD患者的合并症、医疗资源利用（HRU）及相关费用进行了特征分析。
对2011年至2016年德国医疗理赔数据进行回顾性分析。诊断为NAFLD和/或NASH的成年患者被分类为NAFLD、NAFLD非进展者、代偿期肝硬化、失代偿期肝硬化、肝移植或HCC。在每个阶段，测量索引期前后的年度全因HRU和费用。
数据库中的4,580,434例患者中，NAFLD的比例为4.7%（n = 215,655）。其中，36.8%为非进展者，0.2%为代偿期肝硬化，9.6%为失代偿期肝硬化，0.0005%为肝移植，0.2%为HCC。与非进展者相比，代偿期肝硬化、失代偿期肝硬化和HCC的合并症发生率显著更高（心血管疾病分别为52.07%、56.46%、57.58%对27.49%；高血压分别为77.13%、76.61%、83.47%对54.89%；高脂血症分别为47.20%、53.81%、52.89%对35.21%；2型糖尿病分别为49.88%、36.67%、48.21%对20.38%）。晚期肝病患者索引期后的门诊就诊和住院的年均次数显著高于非进展者。晚期肝病患者（代偿期肝硬化，10,291欧元；失代偿期肝硬化，22,561欧元；肝移植，34,089欧元；HCC，35,910欧元）的年均费用显著高于非进展者（3,818欧元，P < 0.001，肝移植队列除外）。在调整基线人口统计学和合并症后，这一趋势仍然一致。
德国的NAFLD患者严重漏诊，占用了大量医疗资源并带来经济负担，尤其是那些患有晚期肝病的患者。需要采取最佳策略进行早期识别和管理，以预防疾病进展并限制不断上升的费用。
