This article is more than 5 years old. Information may no longer be current.
Prevalence of NAFLD creates economic burden in US, Europe
Nonalcoholic fatty liver disease is the most common chronic liver disease worldwide, and according to recent findings, it creates a clinical and economic burden for both the United States and parts of Europe.
“Given the growing epidemic of obesity, diabetes, and NAFLD, this study brings to the attention of policymakers, providers, pharmaceutical companies, payers, and patients the critical importance of understanding NAFLD and establishing a policy for prevention, early detection, and effective therapy,” Zobair Younossi, MD, MPH, chairman of the department of medicine, Inova Fairfax Hospital, and vice president for research of Inova Health System, said in a press release. “This requires a multi-faceted national and possibly international policy to deal with this common, debilitating, and expensive liver disease.”
Younossi and colleagues developed five Markov-based models to estimate the burden of NAFLD in the U.S., France, United Kingdom, Germany and Italy. Models were built using a series of interlinked Markov chains, each representing age increments of people with NAFLD and the general population.
They studied how patients with NAFLD transitioned between nonalcoholic fatty liver, nonalcoholic steatohepatitis, NASH-fibrosis, NASH-compensated cirrhosis, NASH-decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, post-liver transplant and mortality.
Incidence and remission rates were calculated by calibrating against real-world prevalence rates.
The researchers validated their data via a computerized disease model.
Results showed 64 million people in the U.S. are projected to have NAFLD. A projection of more than 12 million incidences of NAFL and over 600,000 incidences of NASH in the U.S. were predicted. These were similar to predictions for the European countries as well. The rate of incidence for cirrhosis, HCC due to NAFLD and liver transplant due to NAFLD were also significantly high, with disease peak between ages 45 and 64.
The annual economic burden of NAFLD in the U.S. is expected to reach $103 billion per year for direct costs compared with 27.7 billion euros in Germany, France and Italy together, and 5.24 billion pounds in the U.K. Costs are higher in the U.S. due to larger population and higher costs of managing disease-related complications.
“This will also increase the per-patient costs,” the researchers wrote.
The cost per-patient in the U.S. will be $1,163 and between 354 and 1,163 euros per-patient in the other countries. The economic burden of NAFLD will be even higher when including societal costs and indirect costs.
Total costs were highest in adults aged 45 to 65 years, but per-patient costs were highest in patients aged 65 years older, reflecting the higher proportion of these patients in more advanced stages of disease, per the researchers.
“The differences in direct economic burden between countries are reflective of the different component costs of care; differences in projected societal burden reflect differences in willingness to pay per [quality-adjusted life-year] gained in these markets,” the researchers wrote.
They concluded: “Despite the enormous economic burden estimated by this analysis, it is most likely that we have underestimated the economic burden of the disease due to conservative assumptions related to the clinical burden and the disease progression rates. Nevertheless, our analysis provides an economic basis to appreciate the actual burden of NAFLD, NASH, and their complications to society.” – by Melinda Stevens
Disclosure: Younossi reports consulting for AbbVie, Bristol-Myers Squibb, Gilead and Intercept, and serving on advisory committees or review panels for AbbVie and Bristol-Myers Squibb.