Economic and Clinical Burden of Nonalcoholic Steatohepatitis in Patients With Type 2 Diabetes in the U.S.

Abstract

Nonalcoholic steatohepatitis (NASH) is a progressive form of nonalcoholic fatty liver disease (NAFLD) and is strongly associated with type 2 diabetes mellitus (T2DM). Patients with both T2DM and NASH have increased risk for adverse clinical outcomes, leading to higher risk for mortality and morbidity. We built a Markov model with 1-year cycles and 20-year horizon to estimate the economic burden of NASH with T2DM in the U.S. RESEARCH DESIGN AND METHODS Cohort size was determined by population size, prevalence of T2DM, and prevalence and incidence of NASH in 2017. The model includes 10 health statesdNAFL, NASH fibrosis stages F0 through F3, compensated and decompensated cirrhosis, hepatocellular carcinoma, 1 year post-liver transplant, and post-liver transplantdas well as liver-related, cardiovascular, and background mortality. Transition probabilities were calculated from meta-analyses and literature. Annual costs for NASH and T2DM were taken from literature and billing codes. RESULTS We estimated that there were 18.2 million people in the U.S. living with T2DM and NAFLD, of which 6.4 million had NASH. Twenty-year costs for NAFLD in these patients were $55.8 billion. Over the next 20 years, NASH with T2DM will account for 65,000 transplants, 1.37 million cardiovascular-related deaths, and 812,000 liver-related deaths. CONCLUSIONS This model predicts significant clinical and economic burden due to NASH with T2DM over the next 20 years. In fact, this burden may be greater since we assumed conservative inputs for our model and did not increase costs or the incidence of T2DM over time. It is highly likely that interventions reducing morbidity and mortality in NASH patients with T2DM could potentially reduce this projected clinical and economic burden. Nonalcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis (.5%) in the absence of excessive alcohol consumption or other causes of fatty liver disease and chronic liver disease (1). NAFLD ranges from simple steatosis (NAFL), which has a low likelihood of progression to advanced liver disease, to nonalcoholic steatohepatitis (NASH), which has greater potential for progression. NAFLD is recognized as one of the most common causes of chronic liver disease in the U.S. and worldwide (1-3). NAFLD is

A diabetologist’s perspective of non‐alcoholic steatohepatitis (NASH): Knowledge gaps and future directions

“…2 However, it is probably higher because more than 90% of the studies used liver ultrasound for the diagnosis, which is less sensitive for intrahepatic triglyceride content than magnetic resonance-based imaging techniques. 3 Recently, Younossi et al 4 reported the significant burden of NASH in patients with T2DM in the United States. The overall prevalence of NAFLD was found to be >70%, or more than 18 million patients with T2DM and NAFLD.…”

Screening for Liver Fibrosis and Steatosis in a Large Cohort of Patients with Type 2 Diabetes Using Vibration Controlled Transient Elastography and Controlled Attenuation Parameter in a Single-Center Real-Life Experience

“…Such patients have an increased risk for developing cirrhosis, and sometimes, hepatocellular carcinoma. A recent study showed that the prevalence of NAFLD in type 2 diabetes is approximately 60% [5]. Other studies from France and Turkey showed that the presence of fibrosis is high in these subjects [6,7].…”

Antidiabetic Therapy in the Treatment of Nonalcoholic Steatohepatitis

“…Seven studies estimated the prevalence of advanced fibrosis in T2D patients with biopsy-proven NAFLD to be 17% (95% CI 7.2-34.8%) [18]. Among 18.2 million people in the US living with T2D and NAFLD, 6.4 million have NASH [19]. In T2D patients, the prevalence of advanced fibrosis is estimated to be 7.3-24.9% by FibroScan and 4.3-7.1% by magnetic resonance elastography (MRE) [20].…”