OBJECTIVES: To compare healthcare utilization among two groups, those with NASH, an elevated NAS score and significant liver fibrosis (SLF; Fibrosis > 2) and those with NASH, a low NAS, and no liver fibrosis (NLF; defined as Fibrosis = 0)

METHODS: A retrospective cohort study was conducted over five years within a large integrated delivery network, focusing on patients with NASH and an elevated NAS score (NAS > 3) who underwent liver biopsies. This study compared two groups: patients with NASH and NLF (n=121) and patients with NASH and SLF (n=111). Healthcare utilization metrics included mean number of medications; emergency department (ED) visits; outpatient (OP) visits; radiology studies; average length of stay (LOS); and number of hospital admissions.

RESULTS: Over the five-year period, patients with NASH and NLF had a lower mean number of medications (52.5 vs. 74.9, p=0.06) and fewer radiology studies (3.2 vs. 7.7, p=0.001) than patients with NASH and SLF. Average LOS was shorter for patients with NLF (4.9 vs. 5.8 days, p=0.28). Patients with SLF had a slightly higher number of ED (6.8 vs. 7.0, p=0.91) and OP visits (68.9 vs. 75.6, p=0.54). Absolute number of admissions was higher for patients with NLF (80 vs. 69), though when adjusted for sample size, the number of admissions per patient was similar (0.66 vs 0.62, p=0.53).

CONCLUSIONS: Patients with NASH and elevated NAS score with significant liver fibrosis demonstrated greater utilization of medications, radiology studies, and overall LOS compared with patients with NASH without fibrosis. This suggests greater disease burden in patients with higher NAS and advanced fibrotic changes. Targeted interventions to delay progression in NAFLD patients may reduce healthcare utilization and the associated costs.