Year 2021 / Volume 113 / Number 6
Original
Overall clinical and economic impact of non-alcoholic fatty liver disease

396-403

DOI: 10.17235/reed.2020.7238/2020

Antoni Sicras-Mainar, Rocío Aller, Javier Crespo, José Luis Calleja, Juan Turnes, Manuel Romero Gómez, Salvador Augustín,

Abstract
Objectives: to establish the clinical and economic consequences (resource utilization and healthcare costs) of non-alcoholic fatty liver in the setting of the usual clinical practice in Spain. Patients and methods: an observational, retrospective study was performed based on a review of the medical records of adult patients ≥ 18 years of age who sought medical care from 2017 to 2018. Patients were categorized into two groups according to fibrosis stage (estimation method: FIB-4): a) F0-F2; and b) F3-F4 (advanced fibrosis). Follow-up lasted one year. Primary endpoints included comorbidity, concomitant medication, resource utilization and costs. Results were analyzed using a multivariate approach with p < 0.05. Results: a total of 8,151 patients were recruited with a mean age of 61.1 years and 51.5 % were male. By group: a) mild fibrosis n = 7,127, 87.4 %; and b) advanced fibrosis n = 1,024, 12.6 % (6.8 % with liver cirrhosis). The most common comorbidities included 63 % dyslipidemia, 52 % obesity, 52 % hypertension and 35 % diabetes. The average number of drugs used was 2.1 per patient. Patients with advanced fibrosis (F3-F4) had a higher average number of concomitant medications (2.5 vs 2.1; p < 0.001) and a higher AST/ALT ratio (1.1 vs 0.8; p < 0.001). The average cost (patient-year) for subjects with advanced fibrosis, corrected for covariates, was higher (€1,812 vs €1,128, p < 0.001). Age, morbidity, concomitant medication, fibrosis stage and total costs were higher in patients with diabetes. Conclusions: patients with advanced fibrosis were associated with more comorbidity and concomitant medications, which resulted in higher healthcare costs for the National Health System.
Share Button
New comment
Comments
No comments for this article
References
1. Moctezuma-Velázquez C. Current treatment for non-alcoholic fatty liver disease. Rev Gastroenterol Mex. 2018;83:125-133.
2. Augustin S, Graupera I, Caballeria J en nombre del grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia. Non-alcoholic fatty liver disease: A poorly known pandemic. Med Clin (Barc). 2017;149:542-548.
3. Reyes-García R, Rozas-Moreno P, Llamoza-Torres CJ, Mezquita-Raya P. Non-alcoholic fatty liver disease and diabetes. Med Clin (Barc). 2017;148:33-38.
4. Skubic C, Drakulić Ž, Rozman D. Personalized therapy when tackling nonalcoholic fatty liver disease: a focus on sex, genes, and drugs. Expert Opin Drug Metab Toxicol. 2018;14:831-841.
5. Hu M, Phan F, Bourron O, Ferré P, Foufelle F. Steatosis and NASH in type 2 diabetes. Biochimie. 2017;143:37-41.
6. Brea Á, Pintó X, Ascaso JF, Blasco M, Díaz Á, González-Santos P, et al. Nonalcoholic fatty liver disease, association with cardiovascular disease and treatment. (I). Nonalcoholic fatty liver disease and its association with cardiovascular disease. Clin Investig Arterioscler. 2017;29:141-148. doi.org/10.1016/j.artere.2016.06.001
7. Cha JY, Kim DH, Chun KH. The role of hepatic macrophages in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Lab Anim Res. 2018;34:133-139.
8. Tanaka N, Kimura T, Fujimori N, Nagaya T, Komatsu M, Tanaka E. Current status, problems, and perspectives of non-alcoholic fatty liver disease research. World J Gastroenterol. 2019;25:163-177.
9. Kowdley KV WL., van Natta ML, Pai RK, et al. Efficacy and safety of vitamin E in nonalcoholic steatohepatitis patients with and without diabetes: Pooled analysis from the PIVENS and FLINT NIDDK NASH CRN Trials. Hepatology. 2015;62(1 Suppl):264A.
10.Younossi Z, Tacke F, Arrese M, Sharma BC, Mostafa I, Bugianesi E, et al. Global Perspectives on Non-alcoholic Fatty Liver Disease and Non-alcoholic Steatohepatitis. Hepatology 2018. doi: 10.1002/hep.30251.
11. Wattacheril J, Issa D, Sanyal A. Nonalcoholic Steatohepatitis (NASH) and Hepatic Fibrosis: Emerging Therapies. Annu Rev Pharmacol Toxicol. 2018;58:649-662.
12. Allen AM, Van Houten HK, Sangaralingham LR, Talwalkar JA, McCoy RG. Healthcare Cost and Utilization in Nonalcoholic Fatty Liver Disease: Real-World Data From a Large U.S. Claims Database. Hepatology. 2018;68:2230-2238.
13. Golabi P, Bush H, Stepanova M, Locklear CT, Jacobson IM, Mishra A, et al. Liver Transplantation (LT) for Cryptogenic Cirrhosis (CC) and Nonalcoholic Steatohepatitis (NASH) Cirrhosis: Data from the Scientific Registry of Transplant Recipients (SRTR): 1994 to 2016. Medicine (Baltimore). 2018;97:e11518.
14. Sun W, Cui H, Li N, Wei Y, Lai S, Yang Y, et al. Comparison of FIB-4 index, EHGNA fibrosis score and BARD score for prediction of advanced fibrosis in adult patients with non-alcoholic fatty liver disease: A meta-analysis study. Hepatol Res. 2016;46:862-70.
15. Deng H, Qi X, Guo X. Diagnostic Accuracy of APRI, AAR, FIB-4, FI, King, Lok, Forns, and FibroIndex Scores in Predicting the Presence of Esophageal Varices in Liver Cirrhosis: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015;94:e1795.
16. Sterling RK, Lissen E, Clumek CK, Sola R, Cassia-Correa M, Montaner J, et al. Development of a simple non-invasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317–25.
17. Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-383.
18. The Anatomical Therapeutic Chemical Classification System with Defined Daily Doses (ATC/DDD): World Health Organization. Disponible en: http://www.who.int/classifications /atcddd/en/. Acceso: enero de 2019.
19. Instituto Nacional de Estadística 2014. Encuesta de costes laborales del año 2014. Disponible: http://www.ine.es/infoine (acceso: enero de 2019).
20. Berger ML, Sox H, Willke RJ. Good Practices for Real‐World Data Studies of Treatment and/or Comparative Effectiveness: Recommendations from the Joint ISPOR‐ISPE Special Task Force on Real‐World Evidence in Health Care Decision Making. Value Health. 2017;20: 1003-1008.
21. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and nonalcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34: 274-85.
22. Li X, Xu H, Gao P. Fibrosis Index Based on 4 Factors (FIB-4) Predicts Liver Cirrhosis and Hepatocellular Carcinoma in Chronic Hepatitis C Virus (HCV) Patients. Med Sci Monit. 2019;25:7243-7250.
23. Srivastava A, Jong S, Gola A, Gailer R, Morgan S, Sennett K, et al. Cost-comparison analysis of FIB-4, ELF and fibroscan in community pathways for non-alcoholic fatty liver disease.. BMC Gastroenterol. 2019;19:122.
24. Caballeria L, Augustin S, Broquetas T, Morillas RM, Vergara M, Virolés S, et al. Recommendations for the detection, diagnosis and follow-up of patients with non-alcoholic fatty liver disease in primary and hospital care. Med Clin (Barc). 2019;153:169-177.
25. Weiß J, Rau M, Geier A. Non-alcoholic fatty liver disease: epidemiology, clinical course, investigation, and treatment. Dtsch Arztebl Int. 2014;111:447-52. doi: 10.3238/arztebl.2014.0447.
26. Araújo AR, Rosso N, Bedogni G, Tiribelli C, Bellentani S. Global epidemiology of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: What we need in the future. Liver Int. 2018;38 Suppl 1:47-51.
27. Bellentani S. The epidemiology of non-alcoholic fatty liver disease. Liver Int. 2017;37 Suppl 1:81-84.
28. Ghamar Chehreh ME, Vahedi M, Pourhoseingholi MA, Ashtari S, Khedmat H, Amin M, et al. Estimation of diagnosis and treatment costs of non- alcoholic fatty liver disease: a two-year observation. Hepat Mon. 2013;13:e7382.
29. Tanajewski L, Harris R, Harman DJ, Aithal GP, Card TR, Gkountouras G, et al. Economic evaluation of a community based diagnostic pathway to stratify adults for non-alcoholic fatty liver disease: a Markov model informed by a feasibility study. BMJ Open. 2017;7:e015659. doi:10.1136/bmjopen-2016-015659
30. Younossi ZM, Henry L. Economic and Quality-of-Life Implications of Non-Alcoholic Fatty Liver Disease. Pharmacoeconomics. 2015;33:1245-53.
31. Sicras Mainar A, Huerta A, Navarro Artieda R, Monsó E, Landis SH, Ismaila AS. Economic impact of delaying initiation with multiple-inhaler maintenance triple therapy in Spanish patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2019;14:2121-2129.
32. Sicras-Mainar A, Rejas-Gutiérrez J, Pérez-Paramo M, Sánchez-Alvarez L, Navarro-Artieda R, Darbà J. Consequences on economic outcomes of generic versus brand-name drugs used in routine clinical practice: the case of treating peripheral neuropathic pain or generalized anxiety disorder with pregabalin.Expert Rev Pharmacoecon Outcomes Res. 2019;19:45-57.
33. Aller R, Fernández-Rodríguez C, Lo Iacono O, Bañares R, Abad J, Carrión JA, et al. Consensus document. Management of non-alcoholic fatty liver disease (NAFLD). Clinical practice guideline. Gastroenterol Hepatol. 2018;41:328-349.
doi:https://doi.org/10.1016/j.artere.2016.06.001
Related articles

Review

Psoriasis and fatty liver: a harmful synergy

DOI: 10.17235/reed.2019.6263/2019

Citation tools
Sicras-Mainar A, Aller R, Crespo J, Calleja J, Turnes J, Romero Gómez M, et all. Overall clinical and economic impact of non-alcoholic fatty liver disease. 7238/2020


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 653 visits.
This article has been downloaded 391 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 08/05/2020

Accepted: 14/06/2020

Online First: 23/11/2020

Published: 04/06/2021

Article revision time: 32 days

Article Online First time: 199 days

Article editing time: 392 days


Share
This article has been rated by 1 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology