Ossima Arnaud Nze, Brzustowski Angélique, Paradis Valérie, Van Beers Bernard, Postic Catherine, Laouénan Cédric, Pol Stanislas, Castéra Laurent, Gautier Jean-François, Czernichow Sebastien, Vallet-Pichard Anais, Larger Etienne, Serfaty Lawrence, Zins Marie, Valla Dominique, Zaleski Isabelle Durand
DRCI- Health economics, Assistance Publique-Hôpitaux de Paris, Hôpital de l'Hôtel Dieu, 75004, Paris, France.
Université Paris Cité, INSERM, Centre de recherche sur l'inflammation, F-75018, Paris, France.
Clin Diabetes Endocrinol. 2024 Apr 25;10(1):9. doi: 10.1186/s40842-023-00163-4.
BACKGROUND & AIMS: Despite its high prevalence in the western world metabolic dysfunction-associated steatotic liver disease (MASLD) does not benefit from targeted pharmacological therapy. We measured healthcare utilisation and identified factors associated with high-cost MASLD patients in France.
The prevalent population with MASLD (including non-alcoholic steatohepatitis) in the CONSTANCES cohort, a nationally representative sample of 200,000 adults aged between 18 and 69, was linked to the French centralised national claims database (SNDS). Study participants were identified by the fatty liver index (FLI) over the period 2015-2019. MASLD individuals were classified according as "high-cost" (above 90th percentile) or "non-high cost" (below 90th percentile). Factors significantly associated with high costs were identified using a multivariate logistic regression model.
A total of 14,437 predominantly male (69%) participants with an average age of 53 ± SD 12 years were included. They mainly belonged to socially deprived population groups with co-morbidities such as diabetes, high blood pressure, mental health disorders and cardiovascular complications. The average expenditure was €1860 ± SD 4634 per year. High-cost MASLD cost €10,863 ± SD 10,859 per year. Conditions associated with high-cost were mental health disorders OR 1.79 (1.44-2.22), cardiovascular diseases OR 1.54 (1.21-1.95), metabolic comorbidities OR 1.50 (1.25-1.81), and respiratory disease OR 1.50 (1.11-2.00). The 10% high-cost participants accounted for 58% of the total national health care expenditures for MASLD.
Our results emphasize the need for comprehensive management of the comorbid conditions which were the major cost drivers of MASLD.
尽管代谢功能障碍相关脂肪性肝病（MASLD）在西方世界的患病率很高，但目前尚无针对性的药物治疗方法。我们对法国医疗资源的利用情况进行了评估，并确定了与高成本MASLD患者相关的因素。
CONSTANCES队列是一个具有全国代表性的样本，包含200,000名年龄在18至69岁之间的成年人，我们将其中患有MASLD（包括非酒精性脂肪性肝炎）的人群与法国国家集中索赔数据库（SNDS）进行了关联。通过2015年至2019年期间的脂肪肝指数（FLI）确定研究参与者。MASLD个体被分为“高成本”（高于第90百分位数）或“非高成本”（低于第90百分位数）。使用多变量逻辑回归模型确定与高成本显著相关的因素。
总共纳入了14,437名参与者，其中男性占主导（69%），平均年龄为53±标准差12岁。他们主要属于社会经济地位较低且患有糖尿病、高血压、心理健康障碍和心血管并发症等合并症的人群。每年的平均支出为1860欧元±标准差4634欧元。高成本MASLD患者每年的花费为10,863欧元±标准差10,859欧元。与高成本相关的疾病包括心理健康障碍，比值比为1.79（1.44 - 2.22）；心血管疾病，比值比为1.54（1.21 - 1.95）；代谢合并症，比值比为1.50（1.25 - 1.81）；呼吸系统疾病，比值比为1.50（1.11 - 2.00）。10%的高成本参与者占MASLD全国医疗总支出的58%。
我们的结果强调了对合并症进行综合管理的必要性，这些合并症是MASLD的主要成本驱动因素。
