5、消化系统肿瘤消化系统肿瘤 (5).pdf
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1、 HepatoBiliary Surgery and Nutrition.All rights reserved.HepatoBiliary Surg Nutr 2019;8(2):181-In the United States(US),the shift in the treatment paradigm following the introduction of second generation direct-acting antiviral(DAA)agents for hepatitis C virus(HCV)infection has favorably transformed
2、 the landscape of end-stage liver disease(ESLD)with a rapid decline in HCV-related liver transplantation;HCV had been the leading indication for liver transplantation for the last two decades(1).While the rate of liver transplantation in patients with HCV infection has plummeted in the US following
3、the widespread application of DAA-based regimens in the pre-transplant setting,the rise in alcohol use disorder and obesity has catapulted alcoholic liver disease(ALD)to become the leading indication for liver transplantation in the US in 2016 followed closely by nonalcoholic steatohepatitis(NASH),a
4、 progressive subset of nonalcoholic liver disease(NAFLD)(1).Despite the decline in HCV-related liver transplantation in the US,the total number of liver transplants per year are on an upward trajectory as a result of marked increase in ESLD associated with ALD and NASHan ominous trend.The approval o
5、f second generation DAA agents in late 2013 heralded a revolutionary era in the treatment of HCV infection.This was portrayed in our recent population-based study in which we showed that prior to the DAA-era between 2007 and 2014,there was a marked increase in HCV-related mortality annual percent ch
6、ange(APC):+2.0%per year,but a marked decrease in HCV-related mortality in the DAA-era from 2014 through 2016(APC:6.4%per year)(2).While HCV-related mortality decreased with the introduction of DAA agents,mortality from ALD and NAFLD has steadily increased from 2007 to 2016.Another study reported tha
7、t in NAFLD-related cirrhosis,age-standardized mortality rates increased significantly between 2007 and 2016(APC:+15.4%;95%confidence interval:14.116.7%)(3).These findings further support the observations reported in a previous population-based study projecting an ongoing increase in the burden of NA
8、FLD between 1988 and 2008 fueled by an unconstrained obesity epidemic in the US(4).While it is likely that NAFLD has a substantial economic impact,complete representative data are still lacking in the US.Based on data from a random sample of national outpatient claims of Medicare beneficiaries,a stu
9、dy noted that the number of outpatient visits for NAFLD increased from 2005 to 2010,and the mean yearly charge and payment increased significantly from$2,624 and$561 in 2005 to$3,608 and$629(P0.05),respectively(5).Recently,Allen et al.analyzed the annual cost of care and resource utilization per pat
10、ient with and without NAFLD between 2010 and 2014 using OptumLabs Data Warehouse,a national claims database of individuals enrolled in private and Medicare Advantage health plans(6).The authors matched 108,420 adults with a first claim for NAFLD to non-NAFLD controls by age,sex,race,geographic regio
11、n,year of diagnosis,metabolic comorbidities,length of follow-up,and insurance type(6).The authors demonstrated that the highest annual cost occurs around a new diagnosis of NAFLD,reaching$7,804 per individual with private insurance and$9,062 per individual with Medicare Advantage,both of which are s
12、ignificantly ViewpointEconomic burden and healthcare utilization in nonalcoholic fatty liver disease Eric R.Yoo1,Aijaz Ahmed2,Donghee Kim21Department of Internal Medicine,Santa Clara Valley Medical Center,San Jose,CA,USA;2Division of Gastroenterology and Hepatology,Stanford University School of Medi
13、cine,Stanford,CA,USACorrespondence to:Donghee Kim,MD,PhD.Division of Gastroenterology and Hepatology,Stanford University School of Medicine,300 Pasteur Drive,Stanford,CA 94304,USA.Email:dhkimmdstanford.edu.Comment on:Allen AM,Van Houten HK,Sangaralingham LR,et al.Healthcare Cost and Utilization in N
14、onalcoholic Fatty Liver Disease:Real-World Data From a Large U.S.Claims Database.Hepatology 2018;68:2230-8.Submitted Dec 12,2018.Accepted for publication Dec 19,2018.doi:10.21037/hbsn.2018.12.11View this article at:http:/dx.doi.org/10.21037/hbsn.2018.12.11183Yoo et al.Healthcare and NAFLD182 HepatoB
15、iliary Surgery and Nutrition.All rights reserved.HepatoBiliary Surg Nutr 2019;8(2):181-higher than the total annual cost of$2,298 in the matched control group.Annual costs for long-term management decreased to$3,789 and$5,363 per individual with private insurance and Medicare Advantage,respectively,
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