Supplementary materials: Costs associated with nonalcoholic steatohepatitis disease progression in Medicare patients: a retrospective cohort study

These are peer-reviewed supplementary materials for the article 'Costs associated with nonalcoholic steatohepatitis disease progression in Medicare patients: a retrospective cohort study' published in the Journal of Comparative Effectiveness Research.Supplemental Figure 1: Event sequencing and cohort construction\Supplemental Table 1: Exclusionary disease codesSupplemental Table 2: Disease state diagnosis and procedure codesAim: Non-alcoholic steatohepatitis (NASH), ormetabolic dysfunction-associated steatohepatitis (MASH), is a severe form of non-alcoholic fatty liver disease (NAFLD) ormetabolic dysfunction-associated liver disease (MASLD), that may progress to advanced liver disease. Costs associated with progression are not well characterized. This study sought to quantify costs and healthcare resource utilization (HRU) associated with NASH progression. Methods: Patients were included if diagnosed with NASH (ICD-10: K75.81) in 100% Medicare claims data (2015–2021) who were ≥66 years at index (diagnosis), continuously enrolled in Parts A, B and D for ≥12 months prior to and 6 months following index (unless death) and who had no evidence of other causes of liver disease. Patient-time was categorized into five severity states: non-cirrhotic NASH, compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC) and liver transplant (LT). Annualized HRU and costs were calculated during the study periods overall and stratified by occurrence and timing of progression. Results: In 14,806 unique patients (n = 12,990 noncirrhotic NASH; 1899 CC; 997 DCC; 209 HCC; 140 LT), mean age and follow-up were 72.2 and 2.8 years, respectively. Average annualized costs increased from baseline following diagnosis, generally scaling with severity: $16,231 to $27,044; $25,122 to $57,705; $40,613 to $181,036; $36,549 to $165,121 and $35,626 to $108,918 in NASH; CC; DCC; HCC; and LT; respectively. Non-cirrhotic NASH and CC patients with progression had higher follow-up spending (1.6x for NASH; 1.7x for CC) than non-progressors (both p < 0.001), 2.8 and 6.1-times higher odds of an inpatient stay and 2.6 and 3.6-times higher odds to be in the top 20% of spenders, respectively, relative to non-progressors (both p < 0.001). Patients progressing within a year had costs 1.4, 1.6, 1.7 and 2.2-times more than year 2, 3, 4 and 5 progressors’ costs, respectively, for noncirrhotic NASH and 1.3, 1.8, 2.0 and 2.2-times more than year 2, 3, 4 and 5 progressors’ costs, respectively, for CC. Conclusion: NASH progression is associated with high costs that increase in more severe disease states. Slower progression is associated with lower costs, suggesting a potential benefit of therapies that may delay or prevent progression.

本数据集为发表于《比较疗效研究杂志》的论文《Medicare患者非酒精性脂肪性肝炎疾病进展相关成本：一项回顾性队列研究》的同行评审补充材料。补充图1：事件序列及队列构建；补充表1：排除性疾病编码；补充表2：疾病状态诊断及程序编码。研究目的：非酒精性脂肪性肝炎（NASH），或称为代谢功能障碍相关脂肪性肝炎（MASH），系一种严重的非酒精性脂肪性肝病（NAFLD）或代谢功能障碍相关肝病（MASLD），可能进展为晚期肝病。与疾病进展相关的成本尚无充分描述。本研究旨在量化NASH进展相关的成本及医疗资源利用（HRU）。研究方法：纳入标准为在100%的Medicare索赔数据（2015-2021年）中被诊断为NASH（ICD-10：K75.81）的患者，在诊断点（诊断时）≥66岁，在诊断前及诊断后6个月内（除非死亡）连续参保A、B和D部分≥12个月，且无其他肝脏疾病原因的证据。患者时间被分为五个严重程度状态：非肝硬化NASH、代偿期肝硬化（CC）、失代偿期肝硬化（DCC）、肝细胞癌（HCC）和肝移植（LT）。在研究期间，总体及按进展发生及时间分层计算了年度化的HRU和成本。研究结果：在14,806名独特患者（n = 12,990非肝硬化NASH；1899 CC；997 DCC；209 HCC；140 LT）中，平均年龄和随访时间分别为72.2岁和2.8年。随着疾病的严重程度增加，平均年度化成本在诊断后从基线上升，大致与严重程度成正比：NASH从16,231美元增加到27,044美元；CC从25,122美元增加到57,705美元；DCC从40,613美元增加到181,036美元；HCC从36,549美元增加到165,121美元；LT从35,626美元增加到108,918美元。非肝硬化NASH和CC患者中，进展者相比非进展者的后续花费更高（NASH为1.6倍；CC为1.7倍），住院机会分别高出2.8倍和6.1倍，进入花费最高的20%的概率分别高出2.6倍和3.6倍。在一年内进展的患者，其成本分别比第2、3、4和5年的进展者成本高出1.4、1.6、1.7和2.2倍，对于CC患者，其成本分别比第2、3、4和5年的进展者成本高出1.3、1.8、2.0和2.2倍。研究结论：NASH进展与高成本相关，且在更严重的疾病状态下成本更高。进展速度较慢与成本较低相关，这表明可能存在延缓或预防进展的疗法的潜在益处。