OBJECTIVES

NASH, the advanced form of non-alcoholic fatty liver disease (NAFLD), is characterized by steatosis with inflammation and liver injury. Individuals with advanced NASH (stage 3 or 4 fibrosis) have an increased mortality rate due to cardiovascular events, cirrhosis, hepatocellular carcinoma, and liver transplant-related complications. There is limited understanding of costs associated with progression to cirrhosis in NAFLD/NASH. The study objective was to estimate healthcare resource utilization (HCRU) and costs incurred by patients with NAFLD/NASH who progress to cirrhosis.

METHODS

Patients with a NAFLD or NASH claim 01-Jan-2006 to 31-Mar-2017 who progressed to cirrhosis were selected from MarketScan^® Commercial and Medicare databases. Cirrhosis diagnosis (compensated [CC]); decompensated [DC]) was the index date. Patients without 12 months continuous enrollment pre-index date or with history of Hepatitis B/C or alcohol abuse were excluded. Patients were stratified by CC or DC and co-morbid Type 2 Diabetes Mellitus (T2DM). Per Patient per Month (PPPM) all-cause healthcare costs and visits were estimated; pre-and post-cirrhosis costs were compared using the Wilcoxon Signed-Rank test.

RESULTS

68,122 patients with NAFLD/NASH and cirrhosis were identified. Overall cohort mean age was 57 years and 57% were women. Cirrhosis diagnosis in NAFLD/NASH occurred at decompensation (62%). PPPM total all-cause healthcare cost significantly increased post-cirrhosis in the overall ($2,555 vs $8,525) cohort, including CC ($1,335 vs $3,711) and DC ($3,313 vs $11,513); T2DM ($2,894 vs $9,038) and patients without T2DM ($2,245 vs $8,056). Corresponding increases in PPPM inpatient, outpatient and emergency visits were observed. In the overall cohort, inpatient costs were 43% of total costs pre-cirrhosis which increased to 62% post-cirrhosis.

CONCLUSIONS

Progression to cirrhosis in patients with NAFLD/NASH is associated with increased HCRU and costs. Identifying patients with NAFLD/NASH at risk of disease progression is necessary. Effective therapies that halt or reverse disease progression may potentially improve morbidity and decrease costs.