Quality of life, economic burden of NASH comparable, worse than type 2 diabetes
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Key takeaways:
- NASH did not differ from type 2 diabetes in mental and work-related impairment.
- Worse physical status, higher activities impairment and more health care provider visits were reported in NASH vs. type 2 diabetes.
Patients with nonalcoholic steatohepatitis experienced similar mental and work-related impairment as patients with type 2 diabetes mellitus but worse physical status, daily activities impairment and more health care resource use.
“As a result of the possible asymptomatic presentation, low disease awareness, low rate of liver biopsy and no approved specific therapies, the prevalence and burden of NASH may be underestimated,” Elliot B. Tapper, MD, associate professor of gastroenterology and internal medicine at University of Michigan Health, and colleagues wrote in BMC Gastroenterology.
“Some published studies describe a substantial health care resource use, impairments in daily activities and reduced health-related quality of life (HRQoL) among NASH patients,” they continued. “However, studies examining the burden of NASH in the United States are limited and more studies are needed to comprehensively examine the humanistic and economic burden of NASH compared to other conditions.”
Using data from the 2016 National Health and Wellness Survey, Tapper and colleagues compared HRQol measures, health care resource use, and work productivity and activity impairment among 136 patients with NASH (mean age, 49.9 years; 61.8% women), 8,175 patients with type 2 diabetes (mean age, 60.1 years; 46.7% women) and 96,108 controls (mean age, 46.3 years; 57.6% women) from the general population.
Compared with 544 matched individuals from the general population, patients with NASH reported “significantly lower” mental (43.19 vs. 46.22) and physical (42.04 vs. 47.1) status, as well as higher rates of anxiety (37.5% vs. 25.5%) and depression (43.4% vs. 30.1%). Patients with NASH also had more provider visits (8.43 vs. 5.17), ER visits (0.73-0.38) and hospitalizations (0.43 vs. 0.2), and higher overall work (39.6% vs. 26.2%) and activity (44.7% vs. 30.8%) impairment.
Researchers also compared the NASH cohort to 272 matched individuals with type 2 diabetes mellitus. While mental status and work productivity scores did not differ among the two groups, patients with NASH had significantly worse physical status (40.52 vs. 44.58) and higher anxiety (39.9% vs. 27.8%), as well as more provider visits (8.63 vs. 5.68) and greater activity impairment (47.14% vs. 36.07%).
“This study conducted within the National Health and Wellness Survey in U.S. as a mirror of the previously published National Health and Wellness Survey from five European countries indicate that NASH patients in the U.S. encounter a substantial burden of disease, which is worse compared to a sample of the general population and at least comparable or worse in some outcomes to type 2 diabetes mellitus patients,” Tapper and colleagues concluded. “This reveals that NASH might be less a ‘silent’ disease but a disease for which the burden on patients is less recognized.”
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