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Nonalcoholic fatty liver disease: impact on healthcare resource utilization, liver transplantation and mortality in a large, integrated healthcare system

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background and aims

NAFLD is the most prevalent liver disease globally, affecting 20% of the world population. Healthcare resource utilization (HRU) attributable to NAFLD has been difficult to define.

Methods

We performed a case control study on NAFLD patients from 2005 to 2015 in a large integrated healthcare system with an affiliated insurance company that prospectively captures HRU information. Outcomes encompassed costs, liver transplantation and mortality rates.

Results

There were 17,085 patients, of which 4512 were NAFLD cases and 12,573 were non-NAFLD controls. The cohorts were similar in age and gender distribution (p > 0.05). The NAFLD cohort had a younger mean age of death (60.9 vs. 63.3, p = 0.004) and had over twice the number of annual healthcare visits (14.6 vs. 7.1). The increased overall annual overall cost attributable to NAFLD (in 2015 $) was $449/year. Overall, NAFLD was independently associated with 17% higher annual attributable healthcare costs. More advanced NAFLD (FS 3–4) was associated with a 40% increase in median annual healthcare costs (vs. FS 0-2). The strongest predictors of HRU among patients with NAFLD were advanced fibrosis and medical co-morbidities. The rate of liver transplantation was 18 times greater (0.054%/year) in the NAFLD compared with the non-NAFLD cohort, while mortality rate was 1.7 times greater.

Conclusions

Within a large, integrated healthcare system a diagnosis of NAFLD is independently associated with a 17% overall excess in HRU and a several-fold increase liver transplantation and mortality. Although the dollar amounts will change over time and between healthcare systems, the proportional need for HRU will have broad applicability and implications.

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Authors and Affiliations

  1. Center for Liver Diseases, The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Thomas Gerard Cotter & Michael Charlton

  2. Intermountain Medical Center, Salt Lake City, UT, USA

    Li Dong, John Holmen, Richard Gilroy, Jake Krong & Michael Charlton

Authors
  1. Thomas Gerard Cotter
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  2. Li Dong
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  3. John Holmen
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  4. Richard Gilroy
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  5. Jake Krong
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  6. Michael Charlton
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Contributions

TC—study design, interpretation of data; drafting of manuscript. LD, JK, JH—acquisition, analysis and interpretation of data, drafting of manuscript; RG—study design, interpretation of data, critical revision of manuscript for important intellectual content; MC—study concept and design; interpretation of data; critical revision of manuscript for important intellectual content. All authors approved final version to be published.

Corresponding author

Correspondence to Michael Charlton.

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Conflict of interest

TGC, LD, JH, JK have no relevant disclosures. RG has received consultant fees from Salix, Gilead, Novartis; and has been on advisory committees for Salix, Gilead, and Novartis. MC has received grant/research support from Gilead, Conatus, Galectin; consultant fees from Gilead, Metacrine, Enterome, Novartis, AbbVie, Intercept, NGM Bio; and has been on an Advisory Committee for Gilead.

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Cotter, T.G., Dong, L., Holmen, J. et al. Nonalcoholic fatty liver disease: impact on healthcare resource utilization, liver transplantation and mortality in a large, integrated healthcare system. J Gastroenterol 55, 722–730 (2020). https://doi.org/10.1007/s00535-020-01684-w

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  • DOI: https://doi.org/10.1007/s00535-020-01684-w

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