Burden of Illness and Economic Model for Patients With Nonalcoholic Steatohepatitis in the United States

Younossi, Zobair M.; Tampi, Radhika P.; Priyadarshini, Massoom; Nader, Fatema; Younossi, Issah; Racila, Andrei

doi:10.1002/hep.30254

Cited by 161 publications

(172 citation statements)

References 34 publications

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confidence: 99%

“…The magnitude of the burden of NAFLD is also seen in economic modeling and population‐based studies . NAFLD‐associated costs over the next 10 years are projected to be an estimated $1.005 trillion in the United States and €334 billion in Europe . Patients with NAFLD also report a decrease in their health‐related quality of life, especially in the area of physical functioning, which affects their ability to work and perform activities of daily living .…”

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Mortality Related to Nonalcoholic Fatty Liver Disease Is Increasing in the United States

et al. 2019

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Population‐level nonalcoholic fatty liver disease (NAFLD) death rate data are sparse. We described death rates for adults with NAFLD in the United States using mortality data from the National Vital Statistics System multiple‐cause mortality data (2007‐2016). Decedents who had NAFLD were identified by International Classification of Diseases (ICD) codes K75.81, K76.0, K74.0, K74.6, and K76.9. Among NAFLD decedents, cause‐specific deaths (e.g., cardiovascular disease [CVD], cirrhosis, hepatocellular carcinoma [HCC], non‐liver cancer, diabetes mellitus [DM]) were identified by underlying cause of death ICD‐10 codes. Trends were evaluated by average annual percentage change (AAPC) in age‐standardized death rate (ASDR) per 100,000 persons. Among the 25,129,960 decedents aged ≥20 years, 353,234 (1.4%) decedents had NAFLD (212,322 men; 260,765 non‐Hispanic whites, 32,868 non‐Hispanic blacks, 46,530 Hispanics, 5,025 non‐Hispanic American Indian or Alaska Natives [AIANs], 7,023 non‐Hispanic Asian or Pacific Islanders [APIs]), with a mean age at death of 64.47 ± 13.17 years. During the study period, the ASDR for NAFLD increased by 15% (12.94 to 14.90; AAPC, 1.98%; P < 0.001]), while women (AAPC, 2.99% vs. 1.16% men; P = 0.003), non‐Hispanic whites (AAPC, 2.48%), non‐Hispanic AIANs (AAPC, 2.31%), and Hispanics (AAPC, 0.74%) experienced the highest annual increases. Stable trends were noted for non‐Hispanic blacks and non‐Hispanic APIs. Among subgroups, Mexican (AAPC, 1.75%) and Asian Indians (AAPC, 6.94%) experienced annual increases. The top six underlying causes of death (155,894 cirrhosis, 38,444 CVD, 19,466 non‐liver cancer, 10,867 HCC, 8,113 DM, and 5,683 lung disease) accounted for 67.5% of NAFLD‐related deaths. For cause‐specific deaths, ASDR increased for HCC (AAPC, 3.82%), DM (AAPC, 2.23%), non‐liver cancer (AAPC, 2.14%), CVD (AAPC, 1.59%), and cirrhosis (AAPC, 0.96%). Conclusion: NAFLD‐related deaths in U.S. adults are increasing. Cirrhosis is the top cause‐specific death, followed by CVD. Women, non‐Hispanic whites, and non‐Hispanic AIANs (subgroups Mexicans and Asian Indians) experienced the highest increases in deaths. Policies addressing the societal burden of NAFLD are needed.

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Mortality Related to Nonalcoholic Fatty Liver Disease Is Increasing in the United States

et al. 2019

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“…The third pillar of the value proposition is the cost outcome—this is assessed by tracking all costs required to deliver clinical and quality outcomes to an individual, to a cohort of patients with a specific diagnosis, or to society …”

Section: Economic Outcomes Assessmentsmentioning

confidence: 99%

“…Value‐based care is supposedly based on what is best for society. However, maximizing value to the society can also bring the highest value to the patient . It is therefore imperative that health care providers aid in determining the best measures of clinical and other patient‐associated outcomes.…”

Section: Economic Outcomes Assessmentsmentioning

confidence: 99%

“…The third pillar of the value proposition is the cost outcome-this is assessed by tracking all costs required to deliver clinical and quality outcomes to an individual, to a cohort of patients with a specific diagnosis, or to society. (54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64) For assessing the economic burden of a disease, different types of models are commonly used: health economic models, cost-effectiveness models, and budget impact models. Each type of analysis is used to answer a certain type of economic question.…”

Section: Economic Outcomes Assessmentsmentioning

confidence: 99%

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Patient‐Reported Outcomes and the Economic Effects of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis: The Value Proposition

Younossi¹

2018

Hepatology

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Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) can progress to cirrhosis, hepatocellular carcinoma (HCC), death, or liver transplantation. NASH has also been associated with impaired health-related quality of life and poses a significant economic burden. Due to the negative clinical and patient-reported outcomes and economic burden of NAFLD, it is necessary to review this disease through the lens of value-based care, in which value is proportional to clinical and quality outcomes and inversely proportional to the costs of delivering these outcomes. I review the components of outcomes measured for patients with NAFLD and NASH and relate them to the value proposition, with the aim to deliver optimal patient-centered care.

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Nonalcoholic Steatohepatitis

Sheka

Adeyi

Thompson

et al. 2020

JAMA

947

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ImportanceNonalcoholic steatohepatitis (NASH) is the inflammatory subtype of nonalcoholic fatty liver disease (NAFLD) and is associated with disease progression, development of cirrhosis, and need for liver transplant. Despite its importance, NASH is underrecognized in clinical practice.ObservationsNASH affects an estimated 3% to 6% of the US population and the prevalence is increasing. NASH is strongly associated with obesity, dyslipidemia, type 2 diabetes, and metabolic syndrome. Although a number of noninvasive tests and scoring systems exist to characterize NAFLD and NASH, liver biopsy is the only accepted method for diagnosis of NASH. Currently, no NASH-specific therapies are approved by the US Food and Drug Administration. Lifestyle modification is the mainstay of treatment, including dietary changes and exercise, with the primary goal being weight loss. Substantial improvement in histologic outcomes, including fibrosis, is directly correlated with increasing weight loss. In some cases, bariatric surgery may be indicated to achieve and maintain the necessary degree of weight loss required for therapeutic effect. An estimated 20% of patients with NASH will develop cirrhosis, and NASH is predicted to become the leading indication for liver transplants in the US. The mortality rate among patients with NASH is substantially higher than the general population or patients without this inflammatory subtype of NAFLD, with annual all-cause mortality rate of 25.56 per 1000 person-years and a liver-specific mortality rate of 11.77 per 1000 person-years.Conclusions and RelevanceNonalcoholic steatohepatitis affects 3% to 6% of the US population, is more prevalent in patients with metabolic disease and obesity, progresses to cirrhosis in approximately 20% of cases, and is associated with increased rates of liver-specific and overall mortality. Early identification and targeted treatment of patients with nonalcoholic steatohepatitis are needed to improve patient outcomes, including directing patients toward intensive lifestyle modification to promote weight loss and referral for bariatric surgery as indicated for management of obesity and metabolic disease.

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Burden of Illness and Economic Model for Patients With Nonalcoholic Steatohepatitis in the United States

Cited by 161 publications

References 34 publications

Mortality Related to Nonalcoholic Fatty Liver Disease Is Increasing in the United States

Mortality Related to Nonalcoholic Fatty Liver Disease Is Increasing in the United States

Patient‐Reported Outcomes and the Economic Effects of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis: The Value Proposition

Nonalcoholic Steatohepatitis

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