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Chronic Liver Disease (CLD) is associated with an increased risk of chronic kidney disease (CKD). However, the health care burden of CKD in the CLD spectrum is unknown. We aimed to evaluate the health care use and cost burdens associated with CKD in patients with CLD in the United States by using real-world claims data. We analyzed data from the Truven Health MarketScan Commercial Claims database from 2010 to 2015. A total of 19,664 patients with CLD with or without comorbid CKD were identified using International Classification of Diseases, Ninth Revision, codes and matched 1:1 by sociodemographic characteristics and comorbidities using propensity scores. Total and service-specific unadjusted and adjusted health care parameters were analyzed for the 12 months following an index date selected at random to capture whole disease burdens. In CLD, comorbid CKD was associated with a higher annual number of claims per person (CKD vs. no CKD, 69 vs. 55) and higher total annual median health care costs (CKD vs. no CKD, $21,397 vs. $16,995). A subanalysis stratified by CKD category showed that health care use and cost burden in CLD increased with disease stage, with a peak 12-month median cost difference of $77,859 in patients on dialysis. The adjusted per person annual health care cost was higher for CKD cases compared to controls ($35,793 vs. $24,048, respectively; P < 0.0001). Stratified by the type of CLD, the highest between-group adjusted cost differences were for cirrhosis, viral hepatitis, hemochromatosis, and nonalcoholic fatty liver disease. Conclusion: CKD is a cost multiplier in CLD. The CKD health care burden in liver disease differs by the type of CLD. Improved CKD screening and proactive treatment interventions for at-risk patients can limit the excess burden associated with CKD in patients with CLD. more...

Hepatic encephalopathy (HE) is a complex condition with multiple causes each with varying degrees of severity. HE negatively impacts patients' quality of life, and it is associated with significant burdens to patients and their caregivers. The prevalence of cirrhosis, the most common risk factor for HE, has steadily increased during recent years. In turn, an upsurge in the clinical and health care burdens related to HE is expected in the upcoming years. This article provides a comprehensive review of the epidemiology of HE. more...

Objectives The healthcare burden associated with porphyria remains unevaluated despite the associated increased risks of morbidity and mortality. We aimed to assess the healthcare utilization and cost burdens of porphyria in the United States (US) using real-world claims data. Methods We performed a case–control analysis of adults in the Truven Health MarketScan® Commercial Claims database (2010–2015). Using propensity scores, 2788 porphyria cases were matched 1:1 to porphyria-free controls with chronic liver disease. Total and service-specific parameters were quantified for the 12 months before porphyria diagnosis versus the 12 months after diagnosis and over the 12 months following a randomly selected date for controls. Wilcoxon signed rank tests and McNemar tests were used to examine incremental differences in burden between cases and controls. Adjusted multivariable generalized linear regression models were used to compare healthcare burdens for cases versus controls. Results Relative to the 12 months before porphyria diagnosis, the following 12 months had more claims per patient (35.94 vs 39.67; p more...

Background: Thrombocytopenia (TCP), a common complication of chronic liver disease (CLD), can cause uncontrolled bleeding during procedures. As such, CLD patients with TCP and platelet counts

BACKGROUND AND AIMS The paucity of data regarding the extent of hepatitis delta virus (HDV) associated health care burden in the United States is an important obstacle to assessing the cost-effectiveness of potential intervention strategies. In this study, we characterized the health care use and cost burdens of HDV in the United States using real-world claims data. APPROACH AND RESULTS We conducted a case-control study using the Truven Health MarketScan Commercial Claims databases from 2011-2014. A total of 2,727 HDV cases were matched 1:1 by sociodemographic characteristics and comorbidities to chronic hepatitis B virus (HBV) controls using propensity scores. The HDV group had significantly higher prevalence of substance abuse, sexually transmitted diseases, decompensated cirrhosis, cirrhosis, and hepatitis C virus compared to patients with chronic HBV. First HDV diagnosis was associated with significant increases in the total number of health care claims (25.61 vs. 28.99; P more...

Background Metabolic syndrome (MetS) is common amongst gout patients. The MetS is diagnosed when a patient has at least 3 of the following 5 conditions of hyperglycemia, hypertension, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol or abdominal obesity. Little is known about the relationship between the cumulative effects of all five metabolic syndrome conditions and the risk of mortality among adult patients with gout. Metabolic Syndrome Severity Score (MetSSS) is a new clinical prediction score that employs available components (sex, age, race, systolic blood pressure, waistline circumference, high-density lipoprotein, triglycerides and fasting blood glucose). MetSSS is a validated summary score that accounts for the combined effects of all 5 metabolic features. MetSSS allows examination of associations between MetS severity and the risk of mortality. Objectives: to use the MetSSS to examine the overall associations between MetS severity and the risk of mortality related to all-causes, cardiovascular disease and diabetes amongst United States (US) gout patients. Methods Mortality-linked data for 12,101 adults aged 18 to 90 years who participated in the Third National Health and Nutrition Examination Survey (NHANES) III (1988-1994) was analyzed. Data from NHANES III were linked to national mortality records for all participants up to time of death or end of study (i.e. 23 years following initial recruitment). All 5 metabolic features were used to calculate gender-race/ethnicity specific MetSSS Z-scores in gout patients. The Z-score is the number of standard deviations from the mean a data point is and allows a continuous representation of all MetS conditions while accounting for gender-race/ethnicity disparities. Results A total of 3,381 deaths were observed, of whom 215 had gout. The prevalence of gout amongst adults was 2.59% (95% CI; 2.13%-3.05%). Moderate to high MetS severity was significantly prevalent among gout patients (47.33% vs. 21.16% no gout; P-value In a disease-specific survival model, a one-unit increase in MetSSS score was associated with a aHR 1.62 (95% CI; 1.21, 2.15) increase in heart disease related mortality among gout patients. Amongst those with gout, a one-unit increase in MetSSS score was associated with increased risks of diabetes- and hypertension- related mortalities aHR 2.53 (95% CI; 1.43, 4.62), aHR 1.73 (95% CI; 1.07, 2.79), respectively. Conclusion The Z score calculation in our study allowed a quantification of increased diabetes- and hypertension- related mortalities, all- cause and cardiovascular mortality in patients with gout. Use of the MetSSS can provide an opportunity to identify patients at highest risk influencing patients to change their lifestyle and better comply with treatment. References [1] Wiley JF, Carrington MJ. A metabolic syndrome severity score: A tool to quantify cardio-metabolic risk factors. Prev Med2016;88:189-195. [2] Thottam GE, Krasnokutsky S, Pillinger MH. Gout and metabolic syndrome: a tangled web. Curr Rheumatol Rep2017;19:60. Disclosure of Interests Naomi Schlesinger Grant/research support from: Pfizer, Consultant for: YesNovartis, Horizon Pharma, Proteo Thera, Selecta Biosciences, Olatec, IFM Therapeutics, Mallinckrodt Pharmaceuticals, Mohamed Elsaid: None declared, Vinod Rustgi Grant/research support from: Genfit, Consultant for: yes Allergan, Zydus, Abbvie more...

Background & Aims Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and increased risk of cancer. The impacts of bariatric surgery on cancer risk in NAFLD patients are unknown. We investigated the effect of bariatric surgery on cancer risk in patients with NAFLD and severe obesity using the MarketScan database. Methods We conducted a retrospective cohort study of 18 to 64 years old newly diagnosed NAFLD patients with severe obesity between 2007 and 2017. We used Cox proportional hazard models to examine the association between bariatric surgery, modeled as a time-varying covariate, and the risks of any cancer and obesity-related cancer, while accounting for confounding using inverse probability of treatment weighting (IPTW). Results A total of 98,090 patients were included in the study, 33,435 (34.1%) received bariatric surgery. In those without surgery, 1898 incident cases of cancer occurred over 115,890.11 person-years of follow-up, compared with 925 cancer cases over 67,389.82 person-years among surgery patients (crude rate ratio, 0.84; 95% CI, 0.77- 0.91). The IPTW-adjusted risk of any cancer and obesity-related cancer was reduced by 18% (hazard ratio, 0.82; 95% CI, 0.76–0.89) and 25% (hazard ratio, 0.65; 95% CI, 0.56–0.75), respectively, in patients with versus without bariatric surgery. The adjusted risks of any cancer and obesity-related cancer were significantly lower in cirrhotic versus non-cirrhotic patients who underwent surgery. In cancer-specific models, bariatric surgery was associated with significant risk reductions for colorectal, pancreatic, endometrial, thyroid cancers, hepatocellular carcinoma, and multiple myeloma. Conclusion Bariatric surgery was associated with significant reductions in the risks of any cancer and obesity-related cancer in NAFLD patients with severe obesity. more...