Clinical and economic burden of nonalcoholic steatohepatitis in Saudi Arabia, United Arab Emirates and Kuwait

Abstract

Background and aims The Middle East (ME) has a high prevalence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), driven by obesity and type-2 diabetes mellitus (T2DM). Studies in Saudi Arabia (KSA) and United Arab Emirates (UAE) predict an escalating impact of NAFLD/NASH, particularly advanced fibrosis due to NASH (AF-NASH), increasing cases of cirrhosis, liver cancer and death. The scale of this burden in other ME countries is unknown with no reports of NAFLD/NASH healthcare resource utilization (HCRU) or costs. We estimated the clinical and economic burden of NAFLD/NASH in KSA, UAE and Kuwait. Methods Markov models populated with country-specific obesity and T2DM prevalence data estimated numbers and progression of NAFLD/NASH patients from 2018 to 2030. Model inputs, assumptions and outputs were collected from literature, national statistics, and expert consensus. Results Over 13 years, the KSA model estimated cases increasing as follows: patients with fibrosis F0–3 doubled to 2.5 m, compensated and decompensated cirrhosis and hepatocellular carcinoma trebled to 212,000; liver failure or transplant patients increased four-fold to 4,086 and liver-related death escalated from < 10,000 to > 200,000. Similar trends occurred in UAE and Kuwait. Discounted lifetime costs of NASH standard-care increased totaling USD40.41 bn, 1.59 bn and 6.36 bn in KSA, UAE (Emiratis only) and Kuwait, respectively. NASH-related costs in 2019 comprised, respectively, 5.83%, 5.80% and 7.66% of national healthcare spending. Conclusions NASH, especially AF-NASH, should be considered a higher priority in ME Public Health policy. Our analyses should inform health policy makers to mitigate the enormity of this escalating regional burden.

Changing trends in liver transplantation indications in Saudi Arabia: from hepatitis C virus infection to nonalcoholic fatty liver disease

“…In SA, the prevalence of overweight (70%), obesity (35%), and physical inactivity (35%) are higher in adults, with a high prevalence of T2DM [ 35 – 38 ]. Undoubtedly, NASH is a consequence of this quadruple-prong epidemic (i.e., syndemic) in SA [ 39 ]. Other potential consequences can include increases in the number of donors with pre-obesity and obesity, which negatively impacts donor complications and LT outcomes for recipients.…”

Disease Progression Modeling for Economic Evaluation in Nonalcoholic Fatty Liver Disease—A Systematic Review

“…Of the 28 articles included in this review, 13 were burden-of-disease studies that did not investigate a particular intervention, of which 6 reported both economic and clinical burden of disease, 19,[27][28][29][30][31] and 7 focused solely on clinical burden of disease. 3,[21][22][23][24][25][26] Eight articles primarily analyzed treatment interventions, 20,[32][33][34][35][36][37][38] of which 1 analyzed a hypothetical treatment.…”

“…In 8 studies, NASH was considered a disease progression from NAFLD and only NASH patients could subsequently develop fibrosis. 27,29,31,39,42,43,45 Tapper et al 44 modeled NAFLD and NASH as 2 separate health states and NAFLD patients could transition to advanced fibrosis without first developing NASH. A similar approach was taken in 7 studies based on the same model.…”

The Troubling Link Between Non-alcoholic Fatty Liver Disease (NAFLD) and Extrahepatic Cancers (EHC)

“…Recent figures suggest that more than 50% of the Omani population is overweight, and 30% have a body mass index (BMI) of more than 30% [ 15 ]. Neighboring countries such as the United Arab Emirates (UAE) and Saudi Arabia which are also struggling with a high burden of obesity have reported a NAFLD prevalence of 25% [ 16 , 17 ], posing a significant economic burden [ 18 ]. A recent analysis of Global Burden of Disease data noted the increasing prevalence of NAFLD across all regions of the world from 1990 to 2017 and pointed out Oman as the country with the maximum increase [ 19 ].…”