TY - JOUR

T1 - Societal costs and survival of patients with biopsy-verified non-alcoholic steatohepatitis

T2 - Danish nationwide register-based study

AU - Rudolfsen, Jan Håkon

AU - Gluud, Lise Lotte

AU - Grønbæk, Henning

AU - Jensen, Majken K.

AU - Vyberg, Mogens

AU - Olsen, Jens

AU - Bo Poulsen, Peter

AU - Hovelsø, Nanna

AU - Gregersen, Nikolaj Ture

AU - Thomsen, Anne Bloch

AU - Jepsen, Peter

N1 - Publisher Copyright: © 2024

PY - 2024

Y1 - 2024

N2 - Introduction and Objectives: Studies on the societal burden of patients with biopsy-confirmed non-alcoholic fatty liver disease (NAFLD) are sparse. This study examined this question, comparing NAFLD with matched reference groups. Materials and Methods: Nationwide Danish healthcare registers were used to include all patients (≥18 years) diagnosed with biopsy-verified NAFLD (1997–2021). Patients were classified as having simple steatosis or non-alcoholic steatohepatitis (NASH) with or without cirrhosis, and all matched with liver-disease free reference groups. Healthcare costs and labour market outcomes were compared from 5 years before to 11 years after diagnosis. Patients were followed for 25 years to analyse risk of disability insurance and death. Results: 3,712 patients with biopsy-verified NASH (n = 1,030), simple steatosis (n = 1,540) or cirrhosis (n = 1,142) were identified. The average total costs in the year leading up to diagnosis was 4.1-fold higher for NASH patients than the reference group (EUR 6,318), 6.2-fold higher for cirrhosis patients and 3.1-fold higher for simple steatosis patients. In NASH, outpatient hospital contacts were responsible for 49 % of the excess costs (EUR 3,121). NASH patients had statistically significantly lower income than their reference group as early as five years before diagnosis until nine years after diagnosis, and markedly higher risk of becoming disability insurance recipients (HR: 4.37; 95 % CI: 3.17–6.02) and of death (HR: 2.42; 95 % CI: 1.80–3.25). Conclusions: NASH, simple steatosis and cirrhosis are all associated with substantial costs for the individual and the society with excess healthcare costs and poorer labour market outcomes.

AB - Introduction and Objectives: Studies on the societal burden of patients with biopsy-confirmed non-alcoholic fatty liver disease (NAFLD) are sparse. This study examined this question, comparing NAFLD with matched reference groups. Materials and Methods: Nationwide Danish healthcare registers were used to include all patients (≥18 years) diagnosed with biopsy-verified NAFLD (1997–2021). Patients were classified as having simple steatosis or non-alcoholic steatohepatitis (NASH) with or without cirrhosis, and all matched with liver-disease free reference groups. Healthcare costs and labour market outcomes were compared from 5 years before to 11 years after diagnosis. Patients were followed for 25 years to analyse risk of disability insurance and death. Results: 3,712 patients with biopsy-verified NASH (n = 1,030), simple steatosis (n = 1,540) or cirrhosis (n = 1,142) were identified. The average total costs in the year leading up to diagnosis was 4.1-fold higher for NASH patients than the reference group (EUR 6,318), 6.2-fold higher for cirrhosis patients and 3.1-fold higher for simple steatosis patients. In NASH, outpatient hospital contacts were responsible for 49 % of the excess costs (EUR 3,121). NASH patients had statistically significantly lower income than their reference group as early as five years before diagnosis until nine years after diagnosis, and markedly higher risk of becoming disability insurance recipients (HR: 4.37; 95 % CI: 3.17–6.02) and of death (HR: 2.42; 95 % CI: 1.80–3.25). Conclusions: NASH, simple steatosis and cirrhosis are all associated with substantial costs for the individual and the society with excess healthcare costs and poorer labour market outcomes.

KW - Burden of disease

KW - Cost

KW - Non-alcoholic steatohepatitis

KW - Real-world data

KW - Survival

U2 - 10.1016/j.aohep.2024.101285

DO - 10.1016/j.aohep.2024.101285

M3 - Journal article

C2 - 38272183

AN - SCOPUS:85185335038

VL - 29

JO - Annals of Hepatology

JF - Annals of Hepatology

SN - 1665-2681

IS - 3

M1 - 101285

ER -