Thomas Gerard Cotter1, Li Dong2, John Holmen2, Richard Gilroy2, Jake Krong2, Michael Charlton3,4. 1. Center for Liver Diseases, The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA. 2. Intermountain Medical Center, Salt Lake City, UT, USA. 3. Center for Liver Diseases, The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA. mcharlton@medicine.bsd.uchicago.edu. 4. Intermountain Medical Center, Salt Lake City, UT, USA. mcharlton@medicine.bsd.uchicago.edu.
Abstract
BACKGROUND AND AIMS: NAFLD is the most prevalent liver disease globally, affecting 20% of the world population. Healthcare resource utilization (HRU) attributable to NAFLD has been difficult to define. METHODS: We performed a case control study on NAFLD patients from 2005 to 2015 in a large integrated healthcare system with an affiliated insurance company that prospectively captures HRU information. Outcomes encompassed costs, liver transplantation and mortality rates. RESULTS: There were 17,085 patients, of which 4512 were NAFLD cases and 12,573 were non-NAFLD controls. The cohorts were similar in age and gender distribution (p > 0.05). The NAFLD cohort had a younger mean age of death (60.9 vs. 63.3, p = 0.004) and had over twice the number of annual healthcare visits (14.6 vs. 7.1). The increased overall annual overall cost attributable to NAFLD (in 2015 $) was $449/year. Overall, NAFLD was independently associated with 17% higher annual attributable healthcare costs. More advanced NAFLD (FS 3-4) was associated with a 40% increase in median annual healthcare costs (vs. FS 0-2). The strongest predictors of HRU among patients with NAFLD were advanced fibrosis and medical co-morbidities. The rate of liver transplantation was 18 times greater (0.054%/year) in the NAFLD compared with the non-NAFLD cohort, while mortality rate was 1.7 times greater. CONCLUSIONS: Within a large, integrated healthcare system a diagnosis of NAFLD is independently associated with a 17% overall excess in HRU and a several-fold increase liver transplantation and mortality. Although the dollar amounts will change over time and between healthcare systems, the proportional need for HRU will have broad applicability and implications.
BACKGROUND AND AIMS: NAFLD is the most prevalent liver disease globally, affecting 20% of the world population. Healthcare resource utilization (HRU) attributable to NAFLD has been difficult to define. METHODS: We performed a case control study on NAFLD patients from 2005 to 2015 in a large integrated healthcare system with an affiliated insurance company that prospectively captures HRU information. Outcomes encompassed costs, liver transplantation and mortality rates. RESULTS: There were 17,085 patients, of which 4512 were NAFLD cases and 12,573 were non-NAFLD controls. The cohorts were similar in age and gender distribution (p > 0.05). The NAFLD cohort had a younger mean age of death (60.9 vs. 63.3, p = 0.004) and had over twice the number of annual healthcare visits (14.6 vs. 7.1). The increased overall annual overall cost attributable to NAFLD (in 2015 $) was $449/year. Overall, NAFLD was independently associated with 17% higher annual attributable healthcare costs. More advanced NAFLD (FS 3-4) was associated with a 40% increase in median annual healthcare costs (vs. FS 0-2). The strongest predictors of HRU among patients with NAFLD were advanced fibrosis and medical co-morbidities. The rate of liver transplantation was 18 times greater (0.054%/year) in the NAFLD compared with the non-NAFLD cohort, while mortality rate was 1.7 times greater. CONCLUSIONS: Within a large, integrated healthcare system a diagnosis of NAFLD is independently associated with a 17% overall excess in HRU and a several-fold increase liver transplantation and mortality. Although the dollar amounts will change over time and between healthcare systems, the proportional need for HRU will have broad applicability and implications.
Authors: Paolo Sorino; Angelo Campanella; Caterina Bonfiglio; Antonella Mirizzi; Isabella Franco; Antonella Bianco; Maria Gabriella Caruso; Giovanni Misciagna; Laura R Aballay; Claudia Buongiorno; Rosalba Liuzzi; Anna Maria Cisternino; Maria Notarnicola; Marisa Chiloiro; Francesca Fallucchi; Giovanni Pascoschi; Alberto Rubén Osella Journal: Sci Rep Date: 2021-10-12 Impact factor: 4.379
Authors: Karuna Rasineni; Clayton W Jordan; Paul G Thomes; Jacy L Kubik; Elizabeth M Staab; Sarah A Sweeney; Geoffrey A Talmon; Terrence M Donohue; Mark A McNiven; Kusum K Kharbanda; Carol A Casey Journal: Front Physiol Date: 2021-03-03 Impact factor: 4.566