title: Direct and Indirect Economic Burden of Chronic Liver Disease in the United States.
abstract: OBJECTIVE
  Chronic liver (CLD) is a major public health concern. We assessed its effects on quality of life and work productivity, as well as its economic burden in the United States.
  
  
  METHODS
  We performed a cross-sectional study of data from the Medical Expenditure Panel Survey (MEPS; 2004-2013). We extracted participants' sociodemographic parameters and medical histories. Subjects with CLD were identified based on Clinical Classification Software codes. MEPS participants were compared between those with and without CLD, and then between employed and unemployed patients with CLD. Outcomes were quality-of-life scores, employment, and health care use.
  
  
  RESULTS
  We collected data from 230,406 adult participants (age, ≥18 y) in the MEPS; 1846 had current CLD (36.7% with viral hepatitis and 5.3% with liver cancer). Individuals with CLD were less likely to be employed (44.7% vs 69.6% patients without CLD), were not working owing to illness/disability (30.5% vs 6.6% without CLD), lost more work because of disability (10.2 vs 3.4 d without CLD), and had more health care use, producing greater health care expenses ($19,390 vs $5567/y without CLD) (all P < .0001). Patients with CLD also had more comorbidities and worse self-reported general and mental health status, and reported more health-related limitations in their daily activities than individuals without CLD (all P < .0001). They also indicated more psychologic distress and depressive symptoms and had a lower quality of life and health utility scores (P < .0001). In multivariate analysis, after adjustment for sociodemographic factors and comorbidities, the presence of CLD was an important predictor of unemployment (odds ratio, 0.60; 95% confidence interval, 0.50-0.70), annual health care expenditure (β = $9503 ± $2028), and impairment in all aspects of health-related quality of life (all P < .0001). In patients with CLD, the presence of liver cancer had the most profound impact on health care expenditures (β = $17,278 ± $5726/y) and physical health (β = -7.2 ± 1.7 for SF-12 physical component) (all P < .005).
  
  
  CONCLUSIONS
  In a cross-sectional analysis of MEPS participants, we associated CLD with large economic and quality-of-life burdens.
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Center for Outcomes Research in Liver Diseases, Washington, District of Columbia.
authors.forename: Maria
authors.initials: M
authors.lastname: Stepanova
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.
authors.forename: Leyla
authors.initials: L
authors.lastname: De Avila
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia.
authors.forename: Mariam
authors.initials: M
authors.lastname: Afendy
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia.
authors.forename: Issah
authors.initials: I
authors.lastname: Younossi
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia.
authors.forename: Huong
authors.initials: H
authors.lastname: Pham
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cable
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia. Electronic address: zobair.younossi@inova.org.
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004526:Efficiency; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D008107:Liver Diseases / Q000191:economics* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Cirrhosis; Costs; HRQOL; NAFLD; Population