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Healthcare resource utilization and costs of nonalcoholic steatohepatitis patients with advanced liver disease in Italy
Institution:1. Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy;2. Gilead Sciences, Inc., Health Economics & Outcomes Research, Foster City, CA, USA;3. CliCon S.r.l. Health Economics & Outcomes Research, Ravenna, Italy;4. Department of Medical and Surgical Sciences, “Alma Mater” University, Bologna, Italy;1. National Reference Centre for Rare Pulmonary Diseases, Louis Pradel University Hospital, Lyon, France;2. Competence Centre for Rare Pulmonary Diseases, AP-HP, Tenon Hospital, Pierre & Marie Curie University, Paris, France;3. Competence Centre for Rare Pulmonary Diseases, Bichat Hospital, Paris, France;4. Competence Centre for Rare Pulmonary Diseases, University Hospital, Besançon, France;5. Competence Centre for Rare Pulmonary Diseases, University Hospital, Rennes, France;6. Competence Centre for Rare Pulmonary Diseases, AP-HP, Georges Pompidou European Hospital, Paris Descartes University, Paris, France;7. Competence Centre for Rare Pulmonary Diseases, University Hospital, Strasbourg, France;8. Competence Centre for Rare Pulmonary Diseases, University Hospital, Marseille, France;9. Competence Centre for Rare Pulmonary Diseases, AP-HP, Avicenne Hospital, and Université Paris 13, Sorbonne Paris Cité, Bobigny, France;10. Competence Centre for Rare Pulmonary Diseases, University Hospital, Lille, France;11. Opened Mind Health, Roubaix, France;1. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana;3. School of Industrial Engineering, Purdue University, West Lafayette, Indiana;4. Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana;6. Center for Innovation, Health Services Research and Development, Roudebush Veterans Affairs Medical Center;5. Regenstrief Institute, Inc, Indianapolis, Indiana;1. Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK;2. St. Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK;3. Faculty of Medicine, Imperial College London, London, UK;1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota;3. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota;4. Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California, San Diego, California;1. UCL Institute for Liver and Digestive Health, Division of Medicine, UCL Medical School, Rowland Hill Street, London NW3 2PF, United Kingdom;2. Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom;3. Public Health Sciences and Medical Statistics, University of Southampton, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, United Kingdom;4. Department of Public Health, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom;5. Infection and Population Health, Institute for Global Health, Faculty of Population Health Sciences, UCL Medical School, Rowland Hill Street, London NW3 2PF, United Kingdom;6. Department of Gastroenterology, The Whittington Hospital NHS Trust, Magdala Avenue, London N19 5NF, United Kingdom;7. Killick Street Practice, Islington Clinical Commissioning Group, 75 Killick Street, King’s Cross, London N1 9RH, United Kingdom;8. Hampstead Group Practice, Camden Clinical Commissioning Group, 75 Fleet Road, Hampstead, London NW3 2QU, United Kingdom;1. Unit of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden;3. Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden;4. Department of Gastroenterology and Hepatology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden;6. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;5. Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
Abstract:Background and aimsNonalcoholic steatohepatitis (NASH) may progress to advanced liver disease (AdvLD). This study characterized comorbidities, healthcare resource utilization (HCRU) and associated costs among hospitalized patients with AdvLD due to NASH in Italy.Methods and resultsAdult nonalcoholic fatty liver disease (NAFLD)/NASH patients from 2011 to 2017 were identified from administrative databases of Italian local health units using ICD-9-CM codes. Development of compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), or liver transplant (LT) was identified using first diagnosis date for each severity cohort (index-date). Patients progressing to multiple disease stages were included in >1 cohort. Patients were followed from index-date until the earliest of disease progression, end of coverage, death, or end of study. Within each cohort, per member per month values were annualized to calculate all-cause HCRU or costs(€) in 2017.Of the 9,729 hospitalized NAFLD/NASH patients identified, 97% were without AdvLD, 1.3% had CC, 3.1% DCC, 0.8% HCC, 0.1% LT. Comorbidity burden was high across all cohorts. Mean annual number of inpatient services was greater in patients with AdvLD than without AdvLD. Similar trends were observed in outpatient visits and pharmacy fills. Mean total annual costs increased with disease severity, driven primarily by inpatient services costs.ConclusionNAFLD/NASH patients in Italy have high comorbidity burden. AdvLD patients had significantly higher costs. The higher prevalence of DCC compared to CC in this population may suggest challenges of effectively screening and identifying NAFLD/NASH patients. Early identification and effective management are needed to reduce risk of disease progression and subsequent HCRU and costs.
Keywords:NASH  NAFLD  HCRU  Costs  NAFLD"}  {"#name":"keyword"  "$":{"id":"kwrd0035"}  "$$":[{"#name":"text"  "_":"Nonalcoholic Fatty Liver Disease  NASH"}  {"#name":"keyword"  "$":{"id":"kwrd0045"}  "$$":[{"#name":"text"  "_":"Nonalcoholic steatohepatitis  AdvLD"}  {"#name":"keyword"  "$":{"id":"kwrd0055"}  "$$":[{"#name":"text"  "_":"advanced liver disease  HCRU"}  {"#name":"keyword"  "$":{"id":"kwrd0065"}  "$$":[{"#name":"text"  "_":"healthcare resource utilization  CC"}  {"#name":"keyword"  "$":{"id":"kwrd0075"}  "$$":[{"#name":"text"  "_":"compensated cirrhosis  DCC"}  {"#name":"keyword"  "$":{"id":"kwrd0085"}  "$$":[{"#name":"text"  "_":"decompensated cirrhosis  HCC"}  {"#name":"keyword"  "$":{"id":"kwrd0095"}  "$$":[{"#name":"text"  "_":"hepatocellular carcinoma  LT"}  {"#name":"keyword"  "$":{"id":"kwrd0105"}  "$$":[{"#name":"text"  "_":"liver transplant  LHU"}  {"#name":"keyword"  "$":{"id":"kwrd0115"}  "$$":[{"#name":"text"  "_":"Local Health Unit  ICD-9-CM"}  {"#name":"keyword"  "$":{"id":"kwrd0125"}  "$$":[{"#name":"text"  "_":"International Classification of Diseases  Ninth Revision  GLM"}  {"#name":"keyword"  "$":{"id":"kwrd0135"}  "$$":[{"#name":"text"  "_":"generalized linear model  CVD"}  {"#name":"keyword"  "$":{"id":"kwrd0145"}  "$$":[{"#name":"text"  "_":"cardiovascular disease
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