OBJECTIVES As the prevalence of nonalcoholic steatohepatitis (NASH) in the elderly population increases, healthcare resource utilization (HCRU) and costs are also predicted to rise substantially. METHODS This retrospective, observational cohort study used the Medicare 20% sample data set to evaluate the impact of NASH severity on HCRU and costs over 8 years (2007-2015). The sample included 255,681 patients with nonalcoholic fatty liver disease (NAFLD)/NASH: 185,407 (72.5%) with NAFLD/NASH and no further progression to advanced liver disease, 3,454 (1.3%) with compensated cirrhosis (CC), 65,926 (25.8%) with decompensated cirrhosis (DCC), 473 (0.2%) with liver transplant (LT), and 421 (0.2%) with hepatocellular carcinoma (HCC). RESULTS Rates of comorbid diabetes, hypertension, hyperlipidemia, and cardiovascular disease were significantly higher in patients with CC or more severe liver disease compared with NAFLD/NASH and no progression. The annual mean number of all-cause healthcare visits increased from 32.1 for NAFLD/NASH with no progression to 37.3 for CC, 59.8 for DCC, 74.1 for LT, and 59.3 for HCC (P < 0.05). Total annual costs for inpatient, outpatient, physician, and pharmacy services rose from $19,908 in NAFLD/NASH with no progression to $129,276 for LT (P < 0.05). Generalized linear model adjusted for patient characteristics and comorbidities revealed that costs were 1.19, 3.15, 5.02, and 3.33 times significantly higher in patients diagnosed with CC, DCC, LT, or HCC, respectively, compared with NAFLD/NASH and no progression. DISCUSSION These results confirm the substantial impact of NASH, particularly more severe disease, on HCRU and costs and identify patients who may benefit from interventions to prevent progression and subsequently reduce HCRU and costs.

中文翻译：

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疾病严重程度与非酒精性脂肪性肝炎医疗保险患者的更高医疗保健利用率相关

目标随着老年人群中非酒精性脂肪性肝炎 (NASH) 的患病率增加，预计医疗资源利用率 (HCRU) 和成本也将大幅上升。方法 这项回顾性、观察性队列研究使用医疗保险 20% 样本数据集来评估 8 年（2007-2015 年）NASH 严重程度对 HCRU 和成本的影响。样本包括 255,681 名患有非酒精性脂肪性肝病 (NAFLD)/NASH 的患者：185,407 名 (72.5%) 患有 NAFLD/NASH 且未进一步进展为晚期肝病，3,454 名 (1.3%) 患有代偿性肝硬化 (CC)，65,926 名 (25.8%) ) 患有失代偿性肝硬化 (DCC)，473 名 (0.2%) 患有肝移植 (LT)，421 名 (0.2%) 患有肝细胞癌 (HCC)。结果 合并糖尿病、高血压、高脂血症、与未进展的 NAFLD/NASH 相比，CC 或更严重肝病患者的心血管疾病和心血管疾病显着升高。全因医疗保健就诊的年平均次数从 NAFLD/NASH 无进展的 32.1 次增加到 CC 的 37.3 次、DCC 的 59.8 次、LT 的 74.1 次和 HCC 的 59.3 次（P < 0.05）。住院、门诊、医生和药房服务的年度总费用从 NAFLD/NASH 的 19,908 美元上升至 LT 的 129,276 美元（P < 0.05）。根据患者特征和合并症调整的广义线性模型显示，与 NAFLD/NASH 且无进展的患者相比，诊断为 CC、DCC、LT 或 HCC 的患者的成本分别显着高出 1.19、3.15、5.02 和 3.33 倍。讨论 这些结果证实了 NASH 的实质性影响，