Modelling the economic and clinical burden of non‐alcoholic steatohepatitis in East Asia: Data from Hong Kong

Abstract

Aim Non‐alcoholic steatohepatitis (NASH) is the progressive form of non‐alcoholic fatty liver disease (NAFLD) and prevalence is rising in Asia due to increasing rates of urbanization, sedentary lifestyles, and poor nutrition. Methods We built a Markov model with 20‐year horizon to estimate the burden of NASH in Hong Kong. Cohort size was determined by population size, prevalence of NAFLD, and incidence of NASH in 2017. Health states include hepatic steatosis, fibrosis stages 0–3, compensated and decompensated cirrhosis, hepatocellular carcinoma, post‐liver transplant, and liver‐related, cardiovascular, and background mortality. Transition probabilities were estimated from published reports and we converted 2017 Gazette price from the Hospital Authority of Hong Kong to US dollars. We discounted costs by 3% annually. Health utilities were assumed to be the same as in the USA. Results Non‐alcoholic steatohepatitis will cost $1.32 billion and 124 liver transplants over 20 years, with average cost per person‐year of $257. Sensitivity analyses show our model is robust in predicting costs for the prevalent population but likely overestimates costs for the incident population. Conclusions Non‐alcoholic steatohepatitis will contribute to a significant clinical and economic burden in Hong Kong over the next two decades. Due to the limited number of donors and small number of liver transplants undertaken annually, patients with advanced liver disease due to NASH in Hong Kong are more likely to die from NASH than their counterparts in North America and Europe. Thus, rising prevalence of metabolic syndrome in elderly adults in Hong Kong make NASH an important consideration for clinicians and policy makers.

WITHDRAWN: Economic Burden of Non-Alcoholic Steatohepatitis with Significant Fibrosis in Thailand

“…This study used Thailand as an example LMIC to re ect the increased burden of NASH in Southeast Asia. Our results are consistent with other studies that claimed that the burden of NAFLD and NASH are large and are ever increasing [13,14,45,46]. The ndings of the present study highlight that the prevention and treatment of NASH should be addressed by every LMIC in the world.…”

“…However, these rates are slightly higher than the global prevalence, which ranges between 3% and 5% [12]. Interestingly, compared with other Asian countries such as China (2.4% [46]), Japan (3.0% [46]) and Hong Kong (4.5% [13]), the estimated NASH prevalence rate for Thailand is higher. This higher prevalence may be in uenced by differences in ethnicity, genetic composition, diets, and sedentary lifestyles [13,47]; however, these contributing factors need to be explored further.…”

“…Interestingly, compared with other Asian countries such as China (2.4% [46]), Japan (3.0% [46]) and Hong Kong (4.5% [13]), the estimated NASH prevalence rate for Thailand is higher. This higher prevalence may be in uenced by differences in ethnicity, genetic composition, diets, and sedentary lifestyles [13,47]; however, these contributing factors need to be explored further. Nevertheless, awareness of this high prevalence for Thailand is important because it could urge clinicians and policy makers to focus on, and prepare for, the signi cant burdens presented by this disease.…”

“…For example, while cirrhosis and HCC need highcost treatments, these diseases typically have poor outcomes. This study only considered NASH and its consequent diseases; when we take the real-world situation into account, there is much evidence that NASH is associated with comorbidities such as diabetes, obesity, dyslipidaemia, metabolic syndrome and cardiovascular diseases [7,13,[55][56][57]. It may also lead to higher mortality and a higher nancial burden for those with underlying diseases [9,35].…”

“…A study on the epidemiology and disease burden of non-alcoholic steatohepatitis suggested that NASH can affect 3-5% of the global population, with minor variations at the country-speci c level [12]. A study focusing on the economic impact of NASH in Hong Kong suggested that the projected cost of NASH over 20 years would be $1.32 billion, at $257 per-person year [13], while a study on the lifetime cost of advanced NASH in the United States demonstrated that the condition costs a total of $96.18 billion, at $139,724 per patient [14].…”