Patients with NASH, T2D Face Costly Financial Burden

Machaon Bonafede

Credit: Veradigm

Results from a recent observational cohort study are calling attention to the economic burden of nonalcoholic steatohepatitis (NASH) and type 2 diabetes (T2D), especially among patients with dual diagnoses.

Average all-cause annual healthcare costs were $7,644 for the NASH-only cohort, increasing 63.2% with the addition of a T2D diagnosis, and $11,515 for the T2D-only cohort, increasing 41.8% with the addition of a NASH diagnosis.¹

“While both NASH and T2D are associated with high annual healthcare costs, the incremental cost of each condition is poorly understood,” wrote investigators.¹

An advanced form of nonalcoholic fatty liver disease, NASH is most common among people who are obese and/or have T2D and is expected to reach 27 million cases in the US by 2030. The annual direct cost of treating NAFLD is as much as $103 billion.²

To assess the incremental cost of NASH and T2D, Machaon Bonafede, vice president of research consulting at Veradigm Life Sciences, and a team of investigators collected electronic health records for adults with ≥2 diagnosis codes for NASH and/or ≥2 diagnosis codes for T2D and ≥24 months of continuous claims enrollment from the Veradigm Network Integrated Dataset. Patients with any diagnosis of viral hepatitis, alcohol-use disorder, alcohol-related liver disease, type 1 diabetes, or gestational diabetes were excluded.¹

Investigators stratified selected patients into 3 cohorts: NASH-only, T2D-only, and NASH with T2D. In total, 23,111 patients were diagnosed with NASH, 3,548,786 with T2D, and 30,339 with both NASH and T2D. The mean age was 52.1 (standard deviation [SD], 14.2) years in the NASH-only cohort, 62.0 (SD, 14.0) years in the T2D-only cohort, and 59.0 (SD, 12.2) years in the NASH with T2D cohort. Participants were 57.4% female in the NASH-only cohort, 56.4% in the T2D-only cohort, and 65.5% in the NASH with T2D cohort.¹

Investigators calculated annualized costs for the 24-month study period and fit a generalized linear model controlling for disease cohort, age, sex, and modified Charlson comorbidity index to estimate the per year all-cause healthcare costs for products and services as well as the incremental cost of adding a T2D or NASH diagnosis. Of note, the top 1% of spenders were excluded to reduce the data skew and a random sample of 100,000 individuals were selected from the T2D diabetes cohort to reduce computing complexity.¹

Among all qualifying individuals, the mean all-cause annual healthcare costs were $10,919 (SD, $57,785) for the NASH-only cohort, $16,728 (SD, $154,614) for the T2D-only cohort, and $22,213 (SD, $180,698) for the NASH with T2D cohort. After excluding patients with costs in the top 1%, investigators noted mean all-cause annual healthcare costs decreased to $7,644 (SD, $14,255) for the NASH-only cohort, $11,515 (SD, $21,946) for the T2D-only cohort, and $16,120 (SD, $26,144) for the NASH with T2D cohort.¹

Further analysis showed the model-predicted mean annual costs for each cohort were closely aligned with the actual costs: $7,668 for the NASH-only cohort, $11,226 for the T2D-only cohort, and $16,812 for the NASH + T2D cohort. Using this model, investigators found the incremental cost increase of adding a T2D diagnosis to the NASH-only population was $4,846, a 63.2% increase totaling a mean cost of $12,513. The incremental cost increase of adding a NASH diagnosis to the T2D-only population was $4,692 for a total mean cost of $15,917, a 41.8% increase.¹

“This real-world data study extends our knowledge of the economic burden of NASH, particularly among patients with comorbid diabetes,” investigators concluded.¹ “This study is significant because it attempts to disentangle the costs of NASH and T2D and assess the incremental costs of each.”

References:

1. Fishman J, Tapper EB, Dodge S, et al. The incremental cost of non-alcoholic steatohepatitis and type 2 diabetes in the United States using real-world data, Current Medical Research and Opinion. doi:10.1080/03007995.2023.2262926
2. Pfizer. NASH. Diseases & Conditions. Accessed October 4, 2023. https://www.pfizer.com/disease-and-conditions/nash