Healthcare Cost and Utilization in Nonalcoholic Fatty Liver Disease: Real-World Data From a Large U.S. Claims Database.
Healthcare Cost and Utilization in Nonalcoholic Fatty Liver Disease: Real-World Data From a Large U.S. Claims Database.
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DOI：
10.1002/hep.30094
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发表时间：
2018-12
期刊：
影响因子：
--
通讯作者：
McCoy RG
中科院分区：
文献类型：
--
作者：
Allen AM;Van Houten HK;Sangaralingham LR;Talwalkar JA;McCoy RG
非酒精性脂肪性肝病（NAFLD）的患病率正在增加。这种复杂疾病的多学科管理所造成的卫生保健负担尚不清楚。我们评估了与新的NAFLD诊断相关的总医疗费用和资源利用，并与具有类似合并症的对照组进行比较。我们使用了OptumLabs数据仓库，这是一个大型的国家行政索赔数据库，拥有超过1亿参加私人和Medicare Advantage健康计划的个人的纵向健康数据。我们确定了2010年至2014年期间首次声称患有NAFLD的152，064名成年人，其中108，420人按年龄，性别，代谢合并症，随访时间，诊断年份，种族，地理区域和保险类型与OLDW数据库中的非NAFLD当代对照组1：1匹配。中位随访时间为2.6（范围1-6.5）年。最终的研究队列包括216，840人，中位年龄为55岁（范围18-86），53%为女性，78%为白色。每名有私人保险的NAFLD患者的年度总护理费用为7，804美元（IQR $3，068-$18，688），用于新诊断和3，789美元（IQR $1，176-$10，539）长期管理。这些成本显著高于具有类似代谢合并症但没有NAFLD的匹配对照的每年总成本2，298美元（IQR 681 - 6，580美元）。与对照组相比，医疗保健利用的最大增加可能是导致NAFLD成本增加的原因，其中包括肝脏活检（RR=55.00，95%CI 24.48-123.59）、成像（RR=3.95，95%CI 3.77-4.15）和住院（RR=1.87，95%CI 1.73-2.02）。与NAFLD相关的护理费用非常高，特别是在首次诊断时。研究工作应侧重于查明使用的基本决定因素、超额费用的来源和开发具有成本效益的诊断测试。
The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing. The health care burden resulting from the multidisciplinary management of this complex disease is unknown. We assessed the total health care cost and resource utilization associated with a new NAFLD diagnosis, compared to controls with similar comorbidities. We used OptumLabs Data Warehouse, a large national administrative claims database with longitudinal health data of over 100 million individuals enrolled in private and Medicare Advantage health plans. We identified 152,064 adults with a first claim for NAFLD between 2010–2014, of which 108,420 were matched 1:1 by age, sex, metabolic comorbidities, length of follow-up, year of diagnosis, race, geographic region and insurance type to non-NAFLD contemporary controls from the OLDW database. Median follow-up time was 2.6 (range 1–6.5) years. The final study cohort consisted of 216,840 people with median age 55 (range 18–86) years, 53% female, 78% white. The total annual cost of care per NAFLD patient with private insurance was $7,804 (IQR $3,068–$18,688) for a new diagnosis and $3,789 (IQR $1,176–$10,539) for long-term management. These costs are significantly higher than the total annual costs of $2,298 (IQR $681–$6,580) per matched control with similar metabolic comorbidities but without NAFLD. The largest increases in healthcare utilization which may account for the increased costs in NAFLD compared to controls are represented by liver biopsies (RR=55.00, 95% CI 24.48–123.59), imaging (RR=3.95, 95% CI 3.77–4.15) and hospitalizations (RR=1.87, 95%CI 1.73–2.02). The costs associated with the care for NAFLD independent of its metabolic comorbidities are very high, especially at first diagnosis. Research efforts should focus on identification of underlying determinants of use, sources of excess cost and development of cost-effective diagnostic tests.
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