Costs Balloon after Cirrhosis Diagnosis for NAFLD/NASH (CME/CE) | IUK Med Online
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Costs Balloon after Cirrhosis Diagnosis for NAFLD/NASH (CME/CE)

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Costs Balloon after Cirrhosis Diagnosis for NAFLD/NASH

Experts say study emphasizes importance of identifying patients early

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  • by Staff Writer, MedPage Today
  • This article is a collaboration between MedPage Today® and:

    Medpage Today

Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • Healthcare costs more than doubled over a 5-year period after a diagnosis of compensated cirrhosis in patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH), according to German healthcare claims data.
  • Note that NAFLD/NASH is a common cause of compensated cirrhosis in Western countries, and these patients often progress to end-stage liver disease.

PARIS — Healthcare costs for patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH) with compensated cirrhosis more than doubled over a 5-year period, a study of claims data in Germany found.

Following a diagnosis of compensated cirrhosis, total healthcare costs for NAFLD/NASH patients increased 169% for patients who progressed to end-stage liver diseases (ESLD) and 132% for those who did not. These increases were mainly due to increased inpatient costs, reported Ali Canbay, MD, of the University of Magdeburg Medical School in Magdeburg, Germany.

At an press conference at the International Liver Congress, the annual meeting for the European Association for the Study of the Liver (EASL), Canbay noted that NAFLD/NASH is a common cause of compensated cirrhosis in Western countries, and that these patients often progress to ESLD, but that limited real-world data exist on healthcare costs and healthcare resource utilization, as well as other health outcomes for these patients.

Identifying these patients early was a theme echoed by experts. David Bernstein, MD, of Northwell Health in Manhasset, New York, said that these patients also have to be identified by their endocrinologist or primary care physician, and that “we only see them once they’ve been found.”

“Something had to be done to identify them to see the specialist, but most of them never see the specialist,” Bernstein, who was not involved in the study, told MedPage Today. “There’s a large population out there with undiagnosed disease, but it’s important to identify it so you can screen for complications that occur.”

Though these results were limited to the German population, David Victor, MD, of Houston Methodist in Houston, characterized these results as “100% applicable to the U.S.”

“This study shows that once these patients reach cirrhosis, it may be too late, as we see with these increased healthcare costs and increased mortality,” he told MedPage Today. Victor was not involved in the study.

Canbay’s group examined anonymized claims data from a German healthcare database from 2011-2016. Using ICD-10 codes, patients with a NAFLD/NASH diagnosis were followed from their diagnosis. They were “flagged” as compensated cirrhosis patients at the first mention of a diagnosis of compensated cirrhosis. “CC progressors” were defined as patients who progressed to ESLD within 1 year following diagnosis, while those who did not were “CC non-progressors.”

Costs were also stratified by CC progressors and non-progressors. Calculation of compensated annual cirrhosis costs, as well as healthcare resource utilization, used a pre-CC index period of 1 year and a post-CC index period of 1 year. Longitudinal costs used a different post-CC index period of 1 up to a maximum of 5 years.

Researchers looked at a total of 800 compensated cirrhosis patients, who were a mean age of about 68; 58% were men. There were 555 CC non-progressors and 245 CC progressors, with CC progressors significantly older than non-progressors (mean age 72 versus 66).

Compensated cirrhosis patients had a substantial comorbidity burden. Around 80% had hypertension, over half had type 2 diabetes, and a little under half had any cardiovascular disease or hyperlipidemia. A little over a third were reported as obese, but Canbay said he thought there was “bias” associated with that number, since “some data are put in from the doctors, and they don’t check that.”

Following a diagnosis of compensated cirrhosis, annual healthcare resource utilization increased substantially, with the portion of patients visiting the emergency department (ED) rising from 22.4% to 41.5%, and the portion of patients requiring hospitalization up from 40.9% to 66.9%. Mean annual number of ED visits and hospitalizations also increased among this population.

As a result, mean annual all-cause healthcare costs rose 93% from the pre-CC index to the post-CC index period (€6,146 to €11,877 or about $7,600 to $14,600), with inpatient costs more than tripling (€2,583 to €8,126). Annual all-cause healthcare costs for CC progressors rose 179%, driven by a 411% increase in inpatient costs following diagnosis, which was significantly higher than CC non-progressors, with a 47% increase in cost and a 103% increase in inpatient costs.

There was around a 20% mortality rate, which was not surprisingly significantly higher for CC progressors compared to non-progressors (46% versus 7.6%).

Press conference moderator Markus Cornberg, MD, of Hannover Medical School in Germany, said the data were “very important for policy makers.”

Canbay and co-authors disclosed no relevant relationships with industry.

2018-04-16T13:00:00-0400
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Medpage Today

Costs Balloon after Cirrhosis Diagnosis for NAFLD/NASH

Experts say study emphasizes importance of identifying patients early

MedpageToday

  • register today

    Earn Free CME Credits by reading the latest medical news in your specialty.

    sign up

  • by Staff Writer, MedPage Today
  • This article is a collaboration between MedPage Today® and:

    Medpage Today

Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • Healthcare costs more than doubled over a 5-year period after a diagnosis of compensated cirrhosis in patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH), according to German healthcare claims data.
  • Note that NAFLD/NASH is a common cause of compensated cirrhosis in Western countries, and these patients often progress to end-stage liver disease.

PARIS -- Healthcare costs for patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH) with compensated cirrhosis more than doubled over a 5-year period, a study of claims data in Germany found.

Following a diagnosis of compensated cirrhosis, total healthcare costs for NAFLD/NASH patients increased 169% for patients who progressed to end-stage liver diseases (ESLD) and 132% for those who did not. These increases were mainly due to increased inpatient costs, reported Ali Canbay, MD, of the University of Magdeburg Medical School in Magdeburg, Germany.

At an press conference at the International Liver Congress, the annual meeting for the European Association for the Study of the Liver (EASL), Canbay noted that NAFLD/NASH is a common cause of compensated cirrhosis in Western countries, and that these patients often progress to ESLD, but that limited real-world data exist on healthcare costs and healthcare resource utilization, as well as other health outcomes for these patients.

Identifying these patients early was a theme echoed by experts. David Bernstein, MD, of Northwell Health in Manhasset, New York, said that these patients also have to be identified by their endocrinologist or primary care physician, and that "we only see them once they've been found."

"Something had to be done to identify them to see the specialist, but most of them never see the specialist," Bernstein, who was not involved in the study, told MedPage Today. "There's a large population out there with undiagnosed disease, but it's important to identify it so you can screen for complications that occur."

Though these results were limited to the German population, David Victor, MD, of Houston Methodist in Houston, characterized these results as "100% applicable to the U.S."

"This study shows that once these patients reach cirrhosis, it may be too late, as we see with these increased healthcare costs and increased mortality," he told MedPage Today. Victor was not involved in the study.

Canbay's group examined anonymized claims data from a German healthcare database from 2011-2016. Using ICD-10 codes, patients with a NAFLD/NASH diagnosis were followed from their diagnosis. They were "flagged" as compensated cirrhosis patients at the first mention of a diagnosis of compensated cirrhosis. "CC progressors" were defined as patients who progressed to ESLD within 1 year following diagnosis, while those who did not were "CC non-progressors."

Costs were also stratified by CC progressors and non-progressors. Calculation of compensated annual cirrhosis costs, as well as healthcare resource utilization, used a pre-CC index period of 1 year and a post-CC index period of 1 year. Longitudinal costs used a different post-CC index period of 1 up to a maximum of 5 years.

Researchers looked at a total of 800 compensated cirrhosis patients, who were a mean age of about 68; 58% were men. There were 555 CC non-progressors and 245 CC progressors, with CC progressors significantly older than non-progressors (mean age 72 versus 66).

Compensated cirrhosis patients had a substantial comorbidity burden. Around 80% had hypertension, over half had type 2 diabetes, and a little under half had any cardiovascular disease or hyperlipidemia. A little over a third were reported as obese, but Canbay said he thought there was "bias" associated with that number, since "some data are put in from the doctors, and they don't check that."

Following a diagnosis of compensated cirrhosis, annual healthcare resource utilization increased substantially, with the portion of patients visiting the emergency department (ED) rising from 22.4% to 41.5%, and the portion of patients requiring hospitalization up from 40.9% to 66.9%. Mean annual number of ED visits and hospitalizations also increased among this population.

As a result, mean annual all-cause healthcare costs rose 93% from the pre-CC index to the post-CC index period (€6,146 to €11,877 or about $7,600 to $14,600), with inpatient costs more than tripling (€2,583 to €8,126). Annual all-cause healthcare costs for CC progressors rose 179%, driven by a 411% increase in inpatient costs following diagnosis, which was significantly higher than CC non-progressors, with a 47% increase in cost and a 103% increase in inpatient costs.

There was around a 20% mortality rate, which was not surprisingly significantly higher for CC progressors compared to non-progressors (46% versus 7.6%).

Press conference moderator Markus Cornberg, MD, of Hannover Medical School in Germany, said the data were "very important for policy makers."

Canbay and co-authors disclosed no relevant relationships with industry.

2018-04-16T13:00:00-0400
Take Posttest Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



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