PSY26 - Real-World Prescription Patterns and Comorbidity Burdens Among Adults with Nonalcoholic Fatty Liver Disease

Abstract

Little research to date has examined the drug utilization pattern among patients with nonalcoholic fatty liver disease (NAFLD). The most recent diagnosis and management guidelines for NAFLD published in 2012 recommended pioglitazone as the effective treatment. In this study, we aim to investigate the real-world drug utilization pattern and comorbidity burden among patients with NAFLD from 2012 to 2015. A retrospective observational study design was employed using the Truven Health MarketScan Commercial Database. Inclusion criteria were: 1) non-elderly patients (age ≥18-<65) who received at least one inpatient or at least two separate outpatient diagnoses of NAFLD (ICD-9: 571.8) between 1/1/2011 and 12/31/2015; 2) available insurance enrollment data for a period of 6-month before and 12-month after the index service date. Patients were excluded if they had one or more claim(s) for type 1 diabetes, chronic hepatitis, alcohol liver diseases, and gestational diabetes. Medications were examined by outpatient prescription claims. The prevalence of each medication was calculated as the number of study subjects taking the specific medication divided by the total number of eligible patients. In the overall study population (N= 76,018) diagnosed with NAFLD, the mean[±SD] age of the patients was 48.4[±10.5] years; 46.8% were male, with a mean[±SD] Charlson comorbidity index score of 1.3[±0.8], 16.9% had type 2 diabetes (T2DM) and 21.2% had lipid metabolism disorders. The proportion of pioglitazone users was 6.2% among patients with co-occurring NAFLD and T2DM, which was six times higher than that of NAFLD patients without T2DM. Compared to the low proportion of pioglitazone uptake among study subjects, metformin was the most frequent prescribed medication among NAFLD patients with T2DM (61.3%) or without T2DM (15.2%). The results showed clinical drug utilization pattern for the management of NAFLD diverged from published guidelines, suggesting promotional programs for pioglitazone use among NAFLD patients are needed.