The incremental cost of non-alcoholic steatohepatitis and type 2 diabetes in the United States using real-world data

Abstract

Background

Non-alcoholic steatohepatitis (NASH) and type 2 diabetes (T2D) are both linked to substantial healthcare costs and are often co-occurring. We aim to quantify the incremental cost of NASH and T2D using real-world data.

Methods

Adults (≥18 years old) with ≥2 diagnosis codes for NASH and/or ≥2 diagnosis codes for T2D between 1/1/2016 and 12/31/2021 and ≥24 months of continuous claims enrollment (study period) were identified in electronic health records or claims in the Veradigm Integrated Dataset. Patients were stratified into 3 cohorts: NASH-only, T2D-only, and NASH + T2D. We calculated annualized costs for the 24-month study period and fit a generalized linear model (excluding the most expensive 1%) that controlled for disease cohort, age, sex, and modified Charlson comorbidity index to estimate the per year all-cause healthcare costs and incremental cost of adding T2D to a NASH diagnosis (or vice versa).

Results

We identified 23,111 patients diagnosed with NASH-only, 3,548,786 patients with T2D-only, and 30,339 patients with NASH + T2D. The model-predicted mean costs per year were $7,668 for patients with NASH-only, $11,226 for patients with T2D-only, and $16,812 for patients with NASH + T2D. The incremental increase in costs per year of adding T2D to NASH was 63% (+$4,846), and the incremental increase in costs per year of adding NASH to T2D was 42% (+$4,692).

Conclusions

Both NASH and T2D contribute to the high healthcare costs among patients with a dual diagnosis. Results from our analysis indicate that NASH comprises a high portion of total healthcare costs among patients with NASH and T2D.

Keywords:

• Adult
• diabetes mellitus, type 2
• non-alcoholic fatty liver disease
• models, economic
• health care costs

Transparency

Declaration of financial/other relationships

AB, DL, and MB are employees of Veradigm, which received fees from Madrigal Pharmaceuticals related to this work. JF, SD, and KM are employees of Madrigal Pharmaceuticals. ET is an employee at the University of Michigan, which received unrestricted financial support to the institution related to this work.

Peer reviewers on this manuscript have received an honorarium from CMRO for their review work but have no other relevant financial relationships to disclose.

Author contributions

All authors contributed to the conceptualization of the study. AB and DL were responsible for data handling and formal analysis of the data. All authors contributed to the development of the methodology implemented in the study, data visualization, interpretation of the results, and writing and revising of the manuscript. All authors approved the final submitted version of the manuscript.

Acknowledgements

Medical writing support was provided by Jessamine Winer-Jones, PhD an employee of Veradigm. This support was funded by Madrigal Pharmaceuticals.

Data availability statement

The data that support the findings of this study were used under license from Veradigm and Komodo Health. Due to data use agreements and its proprietary nature, restrictions apply regarding the availability of the data. Further information is available from the corresponding author.

Additional information

Funding

This study was funded by Madrigal Pharmaceuticals. Employees of Madrigal Pharmaceuticals are co-authors of this study and contributed to the design of the study and interpretation of the data.