Real-world Comorbidity Burden, Health Care Utilization, and Costs of Nonalcoholic Steatohepatitis Patients With Advanced Liver Diseases.

"R.J.W. receives grant/research support from AbbVie and Gilead Sciences and was on the speaker bureau for Salix and Gilead, and serves as a consultant and on the advisory board for Gilead Sciences. N.K. is an employee of Gilead Sciences. D.J.M. was an employee of IBM Watson Health during the course of the study. M.M. is an employee of IBM Watson Health, which received funding from Gilead Sciences to conduct this analysis. A.B.O. is a former employee of Gilead Sciences. S.C.G. receives grant/research support from AbbVie Pharmaceuticals, Conatus, CymaBay, Exalenz, Gilead Sciences, Intercept Pharmaceuticals, and Merck and serves as a consultant/advisor for AbbVie Pharmaceuticals, Dova Pharmaceuticals, Gilead Sciences, Intercept Pharmaceuticals, and Merck."

"NAFLD/NASH imposes a substantial health care burden on the US health care system., Most published data on economic burden of NAFLD/NASH by liver disease severity stages are derived from predictive models that are based on certain assumptions., Although some real-world studies have evaluated changes in HRU and cost burden with NAFLD/NASH progression,,–, these are restricted to patients with and without cirrhosis or derived from limited sources. In the present analysis, among a large sample of patients insured via various providers, inpatient costs were the major contributor for the increase in total costs from preindex to postindex durations for each severity stage. A recent study using a similar study population reported that following a CC diagnosis, the rate of hospitalization increased by 34% and inpatient costs increased by 90%. The exponentially higher adjusted costs with advancing severity stages observed in our study is supported by a previous Medicare study, which reported a higher median annual inpatient and outpatient costs for patients with DCC than noncirrhotic or CC patients. These findings highlight that the majority of the NAFLD/NASH patients are not diagnosed until the disease progresses to the advanced stages. While recent data on head-to-head comparison of health care costs of other liver diseases may not be available, a study quantifying the annual per patient health care costs of hepatitis C virus in US normalized to 2009 dollars ($5330 for CC, $27,845 for DCC, $93,609 for LT, and $43,671 for HCC) suggests that NAFLD/NASH could potentially be more economically taxing to the US health care system, especially in the absence of effective treatment modalities. "