Variables Associated With Inpatient and Outpatient Resource Utilization Among Medicare Beneficiaries With Nonalcoholic Fatty Liver Disease With or Without Cirrhosis.
Variables Associated With Inpatient and Outpatient Resource Utilization Among Medicare Beneficiaries With Nonalcoholic Fatty Liver Disease With or Without Cirrhosis.
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DOI：
10.1097/mcg.0000000000000567
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发表时间：
2017-03
影响因子：
2.9
通讯作者：
Younossi ZM
中科院分区：
文献类型：
--
作者：
Sayiner M;Otgonsuren M;Cable R;Younossi I;Afendy M;Golabi P;Henry L;Younossi ZM
非酒精性脂肪性肝病（NAFLD）是全球慢性肝病的主要原因之一，临床负担巨大。NAFLD的经济负担尚未得到很好的研究。评估NAFLD的经济负担。在没有其他肝脏疾病的情况下，选择了根据国际疾病分类第九版编码诊断为NAFLD的医疗保险受益人（2010年1月1日至2010年12月31日）。住院和门诊资源利用参数是总费用和总供应商付款。将代偿期肝硬化（CC）与失代偿期肝硬化（DC）的NAFLD患者进行比较。共纳入976例住院患者和4742例门诊NAFLD患者-87%为白色，36%为男性，30%患有心血管疾病（CVD）或代谢综合征，12%患有肝硬化。住院病人的总住院费用中位数为36，289元。肝硬化NAFLD患者的费用和支付高于非肝硬化NAFLD患者（61，151美元对33，863美元和18，804美元对10，146美元，P<0.001）。NAFLD合并DC患者的费用和支出均高于CC患者（P<0.02）。门诊病人的总收费中位数为9，011元。肝硬化NAFLD患者的费用和支付高于非肝硬化NAFLD患者（12，049美元对8，830美元和2，586美元对1，734美元，P<0.001）。与CC相比，DC患者的总费用更高（15，187美元对10，379美元，P=0.04）。在多变量分析中，与住院患者资源利用增加相关的变量为住院患者死亡率、DC和CVD;对于门诊患者，有CVD、肥胖和高血压（均P<0.001）。NAFLD与医疗保险的重大经济负担相关。肝硬化和CVD的存在与资源利用增加有关。
Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease worldwide with tremendous clinical burden. The economic burden of NAFLD is not well studied. To assess the economic burden of NAFLD. Medicare beneficiaries (January 1, 2010 to December 31, 2010) with NAFLD diagnosis by International Classification of Diseases, Ninth Revision codes in the absence of other liver diseases were selected. Inpatient and outpatient resource utilization parameters were total charges and total provider payments. NAFLD patients with compensated cirrhosis (CC) were compared with decompensated cirrhosis (DC). A total of 976 inpatients and 4742 outpatients with NAFLD were included—87% were white, 36% male, 30% had cardiovascular disease (CVD) or metabolic syndrome conditions, and 12% had cirrhosis. For inpatients, median total hospital charge was $36,289. NAFLD patients with cirrhosis had higher charges and payments than noncirrhotic NAFLD patients ($61,151 vs. $33,863 and $18,804 vs. $10,146, P<0.001). Compared with CC, NAFLD patients with DC had higher charges and payments (P<0.02). For outpatients, median total charge was $9,011. NAFLD patients with cirrhosis had higher charges and payments than noncirrhotic NAFLD patients ($12,049 vs. $8,830 and $2,586 vs. $1,734, P<0.001). Compared with CC, DC patients had higher total charges ($15,187 vs. $10,379, P=0.04). In multivariate analysis, variables associated with increased inpatient resource utilization were inpatient mortality, DC, and CVD; for outpatients, having CVD, obesity, and hypertension (all P<0.001). NAFLD is associated with significant economic burden to Medicare. Presence of cirrhosis and CVD are associated with increased resource utilization.