Department of Medicine, University of Chicago, Chicago, IL.
Carelon Research, Wilmington, DE.
J Manag Care Spec Pharm. 2024 Dec;30(12):1414-1430. doi: 10.18553/jmcp.2024.24106. Epub 2024 Sep 27.
Metabolic dysfunction-associated steatohepatitis (MASH; formerly nonalcoholic steatohepatitis) is the inflammatory form of metabolic dysfunction-associated steatotic liver disease (formerly nonalcoholic fatty liver disease). MASH is a progressive disease associated with increased risk for many hepatic and extra-hepatic complications such as cirrhosis, hepatocellular carcinoma, the requirement for liver transplantation, and cardiovascular (CV)-related and kidney-related complications. It is important to understand the clinical and economic burden of MASH.
To assess and compare the clinical and economic burdens of MASH in adults with the non-MASH population in a real-world setting.
This observational, retrospective study used the Healthcare Integrated Research Database (HIRD), which contains health care claims data for commercially insured and Medicare Advantage health plan members across the United States. All-cause, CV-related, and liver-related medical costs and health care resource utilization were evaluated in patients with at least 2 diagnoses of MASH during the patient identification period (October 1, 2016, to April 30, 2022) and compared with a non-MASH cohort 1:1 matched on age, Quan Charlson Comorbidity Index, region of residence, and health plan type and length of enrollment. Generalized linear regression with negative binomial and γ distribution models were used to compare health care resource utilization and medical costs, respectively, while controlling for confounders. Covariate-adjusted all-cause, CV-related, and liver-related hospitalization rate ratios and medical cost ratios were assessed and compared for the MASH and matched non-MASH cohorts.
A total of 18,549 patients with MASH were compared with 18,549 matched patients in the non-MASH cohort. After adjusting for covariates, MASH was associated with significantly higher rates of hospitalization and higher medical costs compared with the non-MASH cohort. When compared with the non-MASH cohort, patients with MASH had 1.22 (95% CI = 1.15-1.30; < 0.0001) times higher rates of all-cause hospitalization, 1.13 (95% CI = 1.03-1.24; = 0.008) times higher rates of CV-related hospitalization, and 7.22 (95% CI = 4.91-10.61; < 0.0001) times higher rates of liver-related hospitalization. Similarly, all-cause medical costs were 1.26 (95% CI = 1.22-1.30; < 0.0001) times higher, CV-related medical costs were 1.66 (95% CI = 1.59-1.73; < 0.0001) times higher, and liver-related medical costs were 7.79 (95% CI = 7.42-8.17; < 0.0001) times higher among patients with MASH.
Compared with those of the non-MASH cohort with similar age, Quan Charlson Comorbidity Index, health plan, region of residence, and duration of enrollment, patients with MASH had significantly higher all-cause, CV-related, and liver-related hospitalizations and medical costs.
代谢相关脂肪性肝炎（MASH；以前称为非酒精性脂肪性肝炎）是代谢相关脂肪性肝病（以前称为非酒精性脂肪性肝病）的炎症形式。MASH 是一种进行性疾病，与许多肝脏和肝脏外并发症的风险增加相关，如肝硬化、肝细胞癌、需要进行肝移植以及心血管（CV）相关和肾脏相关并发症。了解 MASH 的临床和经济负担非常重要。
在真实环境中评估和比较 MASH 成年患者与非 MASH 人群的临床和经济负担。
本观察性、回顾性研究使用了 Healthcare Integrated Research Database（HIRD），该数据库包含了美国商业保险和 Medicare Advantage 健康计划成员的医疗保健索赔数据。在患者识别期（2016 年 10 月 1 日至 2022 年 4 月 30 日）期间，对至少有 2 次 MASH 诊断的患者评估了全因、CV 相关和肝脏相关的医疗费用和医疗资源利用情况，并与年龄、Quan Charlson 合并症指数、居住地区、健康计划类型和入组时间匹配的非 MASH 队列进行了 1:1 匹配。使用负二项式和γ分布模型的广义线性回归分别比较了医疗资源利用和医疗费用，同时控制了混杂因素。评估并比较了 MASH 和匹配的非 MASH 队列的全因、CV 相关和肝脏相关住院率比和医疗费用比。
共比较了 18549 例 MASH 患者和 18549 例非 MASH 匹配患者。在调整了混杂因素后，与非 MASH 队列相比，MASH 与更高的住院率和更高的医疗费用相关。与非 MASH 队列相比，MASH 患者的全因住院率高 1.22 倍（95%CI=1.15-1.30；<0.0001），CV 相关住院率高 1.13 倍（95%CI=1.03-1.24；=0.008），肝脏相关住院率高 7.22 倍（95%CI=4.91-10.61；<0.0001）。同样，MASH 患者的全因医疗费用高 1.26 倍（95%CI=1.22-1.30；<0.0001），CV 相关医疗费用高 1.66 倍（95%CI=1.59-1.73；<0.0001），肝脏相关医疗费用高 7.79 倍（95%CI=7.42-8.17；<0.0001）。
与具有相似年龄、Quan Charlson 合并症指数、健康计划、居住地区和入组时间的非 MASH 队列相比，MASH 患者的全因、CV 相关和肝脏相关住院率和医疗费用显著更高。
