Healthcare Cost and Utilization in Nonalcoholic Fatty Liver Disease: Real‐World Data From a Large U.S. Claims Database

Abstract

The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing. The health care burden resulting from the multidisciplinary management of this complex disease is unknown. We assessed the total health care cost and resource utilization associated with a new NAFLD diagnosis, compared with controls with similar comorbidities. We used OptumLabs Data Warehouse, a large national administrative claims database with longitudinal health data of over 100 million individuals enrolled in private and Medicare Advantage health plans. We identified 152,064 adults with a first claim for NAFLD between 2010 and 2014, of which 108,420 were matched 1:1 by age, sex, metabolic comorbidities, length of follow-up, year of diagnosis, race, geographic region, and insurance type to non-NAFLD contemporary controls from the OptumLabs Data Warehouse database. Median follow-up time was 2.6 (range 1-6.5) years. The final study cohort consisted of 216,840 people with median age 55 (range 18-86) years, 53% female, 78% white. The total annual cost of care per NAFLD patient with private insurance was $7,804 (interquartile range [IQR] $3,068-$18,688) for a new diagnosis and $3,789 (IQR $1,176-$10,539) for long-term management. These costs are significantly higher than the total annual costs of $2,298 (IQR $681-$6,580) per matched control with similar metabolic comorbidities but without NAFLD. The largest increases in health care utilization that may account for the increased costs in NAFLD compared with controls are represented by liver biopsies (relative risk [RR] = 55.00, 95% confidence interval [CI] 24.48-123.59), imaging (RR = 3.95, 95% CI 3.77-4.15), and hospitalizations (RR = 1.87, 95% CI 1.73-2.02). Conclusion: The costs associated with the care for NAFLD independent of its metabolic comorbidities are very high, especially at first diagnosis. Research efforts shouldfocus on identification of underlying determinants of use, sources of excess cost, and development of cost-effective diagnostic tests.

The Role of Three‐Dimensional Magnetic Resonance Elastography in the Diagnosis of Nonalcoholic Steatohepatitis in Obese Patients Undergoing Bariatric Surgery

“…One of its most important performance characteristics is the high specificity of 80%, which is advantageous for the identification of individuals with simple steatosis by ruling out those with NASH. Recognizing the low risk of future liver disease for individuals with simple steatosis and focusing on those with NASH will allow for a more targeted therapeutic approach and prevent downstream costs and unnecessary health care resources in a disease with significant economic burden …”

Mortality Related to Nonalcoholic Fatty Liver Disease Is Increasing in the United States

“…The magnitude of the burden of NAFLD is also seen in economic modeling and population‐based studies . NAFLD‐associated costs over the next 10 years are projected to be an estimated $1.005 trillion in the United States and €334 billion in Europe .…”

Patient‐Reported Outcomes and the Economic Effects of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis: The Value Proposition

“…The third pillar of the value proposition is the cost outcome—this is assessed by tracking all costs required to deliver clinical and quality outcomes to an individual, to a cohort of patients with a specific diagnosis, or to society …”

“…Additionally, these costs were higher than matched controls. In fact, the largest increases in the healthcare utilization for NAFLD were related to liver biopsies, imaging and hospitalizations …”

“…The third pillar of the value proposition is the cost outcome-this is assessed by tracking all costs required to deliver clinical and quality outcomes to an individual, to a cohort of patients with a specific diagnosis, or to society. (54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64) For assessing the economic burden of a disease, different types of models are commonly used: health economic models, cost-effectiveness models, and budget impact models. Each type of analysis is used to answer a certain type of economic question.…”