The Economic Burden of Non-Alcoholic Steatohepatitis: A Systematic Review

Abstract

BackgroundThe global prevalence of non-alcoholic steatohepatitis (NASH) is increasing, such that NASH is predicted to become the leading cause of liver transplantation (LT) in the US by 2025. Despite this, data on the economic burden of NASH are limited. Objectives This systematic literature review aimed to summarise and critically evaluate studies reporting on the economic burden of NASH and identify evidence gaps for subsequent research. Methods Medline, EMBASE, the Cochrane Library and EconLit were searched up to 6 January 2021 for English language articles published from January 2010 to January 2021 inclusive that reported economic outcomes of a NASH population or subpopulation. Evidence was presented and synthesised using narrative data analysis, and quality was assessed by two reviewers using an 11-item checklist developed for economic evaluations and adapted to cost of illness. Results Fourteen studies were included, of which five presented data on costs and resource use, four on costs only and five on resource use only. Overall, NASH is associated with a significant and increasing economic burden in terms of healthcare resource utilisation (HCRU) and direct and indirect costs. This burden was higher among NASH patients with advanced (fibrosis stage 3-4) versus early (fibrosis stage 0-2) disease, symptomatic versus asymptomatic disease and for patients with complications or comorbidities versus those without. In LT patients, those with NASH as the primary indication had greater HCRU and higher costs compared with non-NASH indications such as hepatitis B and C viruses. Considerable variability in HCRU and costs was seen across the US and Europe, with the highest costs seen in the US. The quality of the included studies was variable, and the studies themselves were heterogeneous in terms of study methodology, patient populations, comorbidities, follow-up time and outcomes measured. Conclusions This review highlights a general scarcity of NASH-specific economic outcomes data. Despite this, the identified studies show that NASH is associated with a significant economic burden in terms of increased HCRU, and high direct medical and non-medical costs and societal burden that increases with disease severity or when patients have complications or comorbidity. More national-level NASH prevalence data are needed to generate accurate forecasts of HCRU and costs in the coming decades.

Nonalcoholic fatty liver disease from a primary care perspective

“…18 Economic impact increases with NASH severity and is anticipated to grow as the NASH population expands. 19 In the US, NASH prevalence is forecasted to rise by 63% from 16.5 million cases in 2015 to 27 million cases by 2030. 5,20 NASH cirrhosis is the most rapidly increasing cause of liver transplantation in the US.…”

“…The economic impact of NAFLD in the US is substantial, with estimated direct medical costs of $103 billion per year 18 . Economic impact increases with NASH severity and is anticipated to grow as the NASH population expands 19 . In the US, NASH prevalence is forecasted to rise by 63% from 16.5 million cases in 2015 to 27 million cases by 2030 5,20 .…”

Prospective direct comparison of non‐invasive liver tests in outpatients with type 2 diabetes using intention‐to‐diagnose analysis

“…The most recent reviews of NITs in T2D concluded unanimously that there is an unmet need to perform specific prospective studies in outpatients with T2D, using head-to-head comparison, to compare the numerous blood and imaging tests already available in subjects at risk of MASLD. 1,2,[5][6][7][8][9][10][11]27 Here, despite limitations, we succeed to address several unmet needs: first, a prospective head-to-head comparison of widespread NITs focusing in patients with T2D; second, we optimised the performance of an already validated NashFibroTest TA B L E 2 Diagnostic performances of optimised NashFibroTest-T2D versus original NashFibroTest.…”

“…MASLD is underdiagnosed in real‐world clinical settings despite the numerous non‐invasive‐tests (NITs) available, with a high demand for diagnosis and monitoring tests 5‐11 . Differences in the use of different diagnostic tests were also seen depending on the country, with more frequent use of liver biopsy, Nash‐FibroTest, NAFLD fibrosis score, NAFLD activity score and enhanced liver fibrosis score, and less frequent use of FibroScan and some laboratory tests ( e.g ., gamma‐glutamyl‐transpeptidase [GGT] and lipid profile) reported in the United States than European countries 11 …”

The Effects of Probiotics, Prebiotics and Synbiotics in Non-Alcoholic Fat Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH): A Systematic Review

“…Approximately 22.5% of NASH patients will develop hepatocellular carcinoma, and 20% will develop cirrhosis [ 8 , 9 , 10 , 11 ]. This progressive feature makes NASH the second most prevalent cause of liver transplantation in the USA [ 12 ].…”