OBJECTIVES: This study assessed health care costs and predictors of hospitalization among patients diagnosed with non-alcoholic steatohepatitis (NASH) in the US Veterans Health Administration (VHA) population (01APR2013-31MAR2018).

METHODS: Adult patients with ≥1 inpatient diagnosis for NASH (International Classification of Disease, 9^th/10^th Revision, Clinical Modification [ICD-9-CM] codes 571.8,571.9; ICD-10-CM: K76.0, K75.81) during the identification period (01APR2014-31MAR2017) were identified as NASH cases. The first NASH diagnosis date was identified as the index date. Included patients had continuous health plan enrollment ≥1 year pre- (baseline) and post-index date (follow-up period). Patients without a NASH diagnosis (controls) were 1:1 matched to cases based on age, sex, race, and index year. The index date for controls was randomly selected to minimize bias. Health care costs and hospitalization during the 1-year follow-up period were compared between cases and controls. Predictors of hospitalization among NASH cases were examined using logistic regression.

RESULTS: There were 96,850 case-control matches in this study (mean age=58 years). Cases had a higher baseline mean Charlson comorbidity index (CCI) score than controls (1.80 vs 0.87; p<0.0001). During follow-up, more case patients had ≥1 inpatient (12.62% vs 3.14%), outpatient (99.86% vs 66.82%), and pharmacy visit (91.63% vs 63.32%; all p<0.0001). Inpatient ($4,505 vs $1,104), outpatient ($7,004 vs $2,708), pharmacy ($2,209 vs $649), and total costs ($13,718 vs $4,460) were also higher for cases than for controls (all p<0.0001). Age 55-64 years (odds ratio [OR]:1.11; confidence interval [CI]:1.06-1.17), black (OR:1.33; CI:1.18-1.50) or white race (OR:1.21; CI:1.08-1.36) and higher CCI score (OR:1.23; CI:1.22-1.24) were associated with higher odds of hospitalization.

CONCLUSIONS: There is a significant economic burden, including hospitalization, due to NASH among US veterans. The likelihood of hospitalization is higher among older patients with significant comorbidity. Further research is recommended to examine which comorbid conditions raise the likelihood of hospitalization among this population.