Real-World Data Analysis of Healthcare Resource and Cost Utilization From Non-Alcoholic Fatty Liver Disease Patients in Japan

Abstract Background: Demographic, healthcare resource utilization (HCRU), and healthcare costs of non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) patients, and those progressed to liver cirrhosis (LC) and hepatocellular carcinoma (HCC) was assessed from Japan Medical Data Center (JMDC) claims database. Methods: 185,012 NAFLD or NASH patients between 1st January 2006 and 31st July 2018 were identified from JMDC database. Mean annual all-cause HCRU and costs were reported pre- and post-index date of the initial diagnosis of NAFLD/NASH, LC and HCC. Age, gender, and comorbidity influence on post-index cost was assessed with a multivariable analysis. Results: 123,379 NAFLD/NASH, 205 LC, and 96 HCC patients were selected into 3 liver severity cohorts based on the study inclusion/exclusion criteria. Majority of patients were male (70.0% to 71.7%) with comorbid hyperlipidaemia (50.2% to 61.5%), diabetes mellitus (40.0% to 60.4%), and hypertension (27.9 % to 42.7%) most prevalent across the 3 liver disease states. The mean all-cause healthcare annual cost significantly increased with liver disease severity, at ¥146,096, ¥399,425 and ¥842,875 for NAFLD/NASH, LC and HCC patients, respectively. Comorbid cardiovascular disease (CVD), following by type 2 diabetes mellitus (T2DM) had the highest influence on all-cause cost with a cost ratio of 1.77 and 1.45, respectively. Conclusions: NAFLD/NASH patients with LC or HCC have increased comorbidity burden, high HCRU, and healthcare costs, which further highlights the importance and need of timely identification and management for NAFLD and NASH patients in Japan.