Annualized costs for the 24-month study period were highest among patients with both NASH and T2D, highlighting the incremental cost of adding an additional diagnosis for comorbid NASH or T2D.
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.”