Author information
1
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN.
2
Robert D. and Patricia E. Kern, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
3
OptumLabs, Cambridge, MA.
4
Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
5
Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Abstract
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).
CONCLUSIONS:
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.