WITHDRAWN: Economic Burden of Non-Alcoholic Steatohepatitis with Significant Fibrosis in Thailand

Abstract

Background: Non-alcoholic steatohepatitis (NASH) has been recognised as a significant form of chronic liver disease and a common cause of cirrhosis and hepatocellular carcinoma, resulting in a considerable financial burden on healthcare resources. Currently, there is no information regarding the economic burden of NASH in low- and middle-income countries (LMICs). The aim of this study was to estimate the economic burden of NASH in Thailand as a lesson learned for LMICs.Methods: To estimate the healthcare costs and prevalence of NASH with significant fibrosis (fibrosis stage ≥ 2) in the general Thai population, an eleven-state lifetime horizon Markov model with 1-year cycle length was performed. The model comprised Thai population aged 18 years and older. The cohort size was based on Thailand Official Statistic Registration Systems. The incidence of NASH, transitional probabilities, and costs-of-illness were based on previously published literature, including systematic reviews and meta-analyses. The age-specific prevalence of NASH was based on Thai NASH registry data. Costs were expressed in 2019 US Dollars ($). As we undertook analysis from the payer perspective, only direct medical costs were included. All future costs were discounted at an annual rate of 3%. A series of sensitivity analyses were performed.Results: The estimated total number of patients with significant NASH was 2.9 million cases in 2019, based on a NASH prevalence of 5.74%. The total lifetime cost of significant NASH was $15.2 billion ($5,147 per case), representing approximately 3% of the 2019 GDP of Thailand. The probabilistic sensitivity analysis showed that the lifetime costs of significant NASH varied from $11.4 billion to $18.2 billion.Conclusions: The economic burden associated with NASH is substantial in Thailand. This prompts clinicians and policy makers to consider strategies for NASH prevention and management.

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.…”

“…3,[21][22][23][24][25][26] In 3 studies the modeling of NASH/NAFLD was not clearly described. 20,30,40 Six studies explicitly focused on a NASH population. 19,32,35,37,38…”

From MAFLD to hepatocellular carcinoma and everything in between

“…Notably, the total economic burden of MAFLD is highest in adults aged 45 to 65 years, mirroring disease prevalence and duration in the same age group [16] . In 2019, the total lifetime cost of Thai MeSH patients was estimated to be $15.2 billion [29] …”

Review article: the epidemiologic burden of non‐alcoholic fatty liver disease across the world

“…In addition to its association with adverse clinical outcomes, NAFLD has been shown to have a negative impact of patient‐reported outcomes (PROs) such as health‐related quality of life, the ability to be physically active as well as work productivity 20–28 Furthermore, the economic burden of NAFLD has been reported to be quite substantial especially among those with NASH and fibrosis 29–34 …”

“…Finally, despite these substantial clinical, humanistic and economic burden, awareness about NAFLD among patients and healthcare providers remains low 33–36 . In this context, NAFLD is predominantly discovered incidentally and a systematic guideline to identify NAFLD patients at high risk of progression in the primary care setting is currently lacking.…”