Patients With NASH and Type 2 Diabetes Face Costly Financial Burden

A version of this article was originally published by HCPLive®. This version has been lightly edited.

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 $7644 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.

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These findings were published in Current Medical Research and Opinion.¹

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

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

To assess the incremental cost of NASH and T2D, investigators collected electronic health records for adults with 2 or more diagnosis codes for NASH and/or 2 or more diagnosis codes for T2D, as well as at least 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.

Investigators stratified selected patients into 3 cohorts: NASH-only, T2D-only, and NASH with T2D. In total, 23,111 patients had NASH only, 3,548,786 had T2D only, and 30,339 had both NASH and T2D. The mean (SD) age was 52.1 (14.2) years in the NASH-only cohort, 62 (14) years in the T2D-only cohort, and 59 (12.2) years in the NASH with T2D cohort. The study population was 57.4% female in the NASH-only cohort, 56.4% in the T2D-only cohort, and 65.5% in the NASH with T2D cohort.

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 cohort to reduce computing complexity.

Among all qualifying individuals, the mean (SD) all-cause annual health care costs were $10,919 ($57,785) for the NASH-only cohort, $16,728 ($154,614) for the T2D-only cohort, and $22,213 ($180,698) for the NASH with T2D cohort. After excluding patients with costs in the top 1%, investigators noted mean all-cause annual health care costs dropped to $7644 ($14,255), $11,515 ($21,946), and $16,120 ($26,144), respectively.

Further analysis showed the model-predicted mean annual costs for each cohort were closely aligned with the actual costs: $7668 for the NASH-only cohort, $11,226 for the T2D-only cohort, and $16,812 for the NASH with T2D cohort. Using this model, investigators found the incremental cost increase of adding a T2D diagnosis to the NASH-only population was $4846, reflecting a 63.2% increase totaling a mean cost of $12,513. Further, the incremental cost increase of adding a NASH diagnosis to the T2D-only population was $4692, for a 41.8% increase and total mean cost of $15,917.

“This real-world data study extends our knowledge of the economic burden of NASH, particularly among patients with comorbid diabetes,” investigators concluded. “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. Published online September 22, 2023. doi:10.1080/03007995.2023.2262926

2. Pfizer. NASH. Accessed October 4, 2023. https://www.pfizer.com/disease-and-conditions/nash