Friday, April 13, 2018

Germany: compensated cirrhosis substantially increases comorbidities and healthcare costs for patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis

Germany: compensated cirrhosis substantially increases comorbidities and healthcare costs for patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis

European Association for the Study of the Liver

13 April 2018, Paris, France: An analysis of outcomes and costs for German patients with non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH) who develop compensated cirrhosis was presented today at The International Liver Congress™ 2018 in Paris, France. Healthcare costs for this population spiked in the first year after compensated cirrhosis diagnosis. Comorbidities were common and one in five patients died within a year of cirrhosis diagnosis, highlighting the need for new treatment options to improve outcomes in these patients.

NAFLD is a major cause of liver disease worldwide with a global prevalence of 25% that is, alarmingly, thought to be rising, fueled by the global epidemic of obesity.9 The progression from NAFLD to NASH to advanced fibrosis is well established.9 For patients with NAFLD/NASH, increased morbidity and mortality is associated with increasing fibrosis. 10

'We know that compensated cirrhosis is often caused by NASH, but data on the associated morbidity, mortality, healthcare utilization and costs within the population of Germany are lacking', explained Dr Ali Canbay from the University of Magdeburg Medical School in Germany, and lead author of the study. 'We were able to extract these data from a large, anonymized billing database'.

The study presented by Dr Canbay obtained retrospective claims data for adult patients with a NAFLD/NASH diagnosis between 2011 and 2016 using the InGef FDB database (which contains anonymized billing data for about 6.3 million persons in about 60 health insurances in Germany).11,12 A total of 800 patients who had a subsequent diagnosis of compensated cirrhosis were included in the analysis. Of these, 245 (30.6%) individuals progressed to end-stage liver diseases (ESLDs) (progressors) and 555 (69.4%) remained cirrhotic (non-progressors) within 1 year of follow-up after their cirrhosis index diagnosis. Comorbidities, all-cause mortality within 1 year of the cirrhosis index diagnosis, annual healthcare utilization, annual mean costs (1 year pre-index to 1 year post-index period) and cumulative mean costs (1 year to maximum 5 years pre-index and post-index period) were presented.

In the 1-year pre-index period, the most prevalent comorbidities were hypertension (78.8 %), type-2 diabetes mellitus (52.6%), cardiovascular diseases (48.8%) and hyperlipidaemia (47.5%). In the first year of the post-index period, 19.4% of the patients died. This percentage was significantly higher for progressors (46.1%) than non-progressors (7.6%) (p<0.05). Following the cirrhosis diagnosis, the mean annual number of all-cause hospitalizations and emergency room visits increased significantly by 91% and 106.8%, respectively (p<0.05).

During the 1-year pre-index period, the mean of annual all-cause healthcare cost was €6,146 per patient. In the first post-index year there was a substantial and significant increase (93%, p<0.05) in annual all-cause healthcare cost per patient to a mean of €11,877. The primary driver of healthcare costs was the inpatient setting, which accounted for 42.0% of pre-index costs and 68.4% of post-index costs. Cumulative mean costs for cirrhosis patients increased 143% over the 5-year period of the study (p<0.05).

'We demonstrated that German patients with NAFLD/NASH who develop compensated cirrhosis have a substantial burden of comorbidities and that their healthcare costs jump with the development of cirrhosis', said Dr Canbay. 'Novel treatment options are needed to improve patient outcomes'. 'This study highlights the burden of NASH cirrhosis on healthcare systems and reinforces the need for new therapies to tackle the epidemic currently affecting many European countries', said Prof. Phil Newsome from the Queen Elizabeth Hospital and University of Birmingham, UK, and EASL Governing Board Member.

9. Younossi ZM, et al. Global epidemiology of nonalcoholic fatty liver disease - meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73-84.
10. Hagström H, et al. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. J Hepatol. 2017;67(6):1265-73.
11. Andersohn F, Walker J. Characteristics and external validity of the German Health Risk Institute (HRI) Database Pharmacoepidemiol Drug Saf. 2016;25(1):106-9.
12. The Institute for Applied Health Research (InGef). Health research: methods. Available from: Last accessed: February 2018.

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