Z Gastroenterol 2020; 58(08): e174-e175
DOI: 10.1055/s-0040-1716199
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The economic cost and health burden of non-alcoholic steatohepatitis (NASH) in the EU5 countries

J Schattenberg
1   I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
,
P Newsome
2   University of Birmingham, Birmingham, Vereinigtes Königreich
,
L Serfaty
3   Hôpitaux Universitaires de Strasbourg, Strasbourg, Frankreich
,
A Aghemo
4   Humanitas University and Humanitas Research Hospital IRCCS, Pieve Emanuele, Mailand, Italien
,
S Augustin
5   Hospital Universitari Vall d’Hebron - Institut de Recerca, Barcelona, Spanien
,
E Tsochatzis
6   UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, Vereinigtes Königreich
,
A Canbay
7   Universitätsklinikum Magdeburg, Magdeburg, Deutschland
,
V de Ledinghen
8   Centre Hospitalier Universitaire Bordeaux, Bordeaux, Frankreich
,
E Bugianesi
9   University of Torino, Department of Medical Sciences, Turin, Italien
,
M Romero-Gomez
10   Virgen del Rocío University Hospital, Sevilla, Spanien
,
S Ryder
11   Nottingham University Hospitals, Nottingham, Vereinigtes Königreich
,
H Bantel
12   Klinik für Gastroenterologie, Hepatologie und Endokrinologie; Medizinische Hochschule Hannover, Hannover, Deutschland
,
J Boursier
13   Angers University Hospital, Angers, Frankreich
,
S Petta
14   Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italien
,
J Crespo
15   Hospital Universitario Marqués de Valdecilla, Santander, Spanien
,
L Castera
16   Université Paris-7, Department of Hepatology, Hôpital Beaujon, Paris, Frankreich
,
V Leroy
17   Centre Hospitalier Universitaire de Grenoble, Grenoble, Frankreich
,
C Le Pen
18   University Paris-Dauphine, Paris, Frankreich
,
F-U Fricke
19   Technische Hochschule Nürnberg, Nürnberg, Deutschland
,
R Elliott
20   University of Manchester, Manchester, Vereinigtes Königreich
,
V Atella
21   University Rome Tor Vergata, Rom, Italien
,
J Mestre-Ferrandiz
22   Independent Economics Consultant, Madrid, Spanien
,
L Floros
23   PHMR Limited, London, Vereinigtes Königreich
,
A Torbica
24   Bocconi University, Mailand, Italien
,
A Morgan
25   Deloitte, Canberra, Australien
,
S Hartmanis
26   Deloitte, Victoria, Australien
,
A Trylesinki
27   Intercept Pharmaceuticals, London, Vereinigtes Königreich
,
S Cure
27   Intercept Pharmaceuticals, London, Vereinigtes Königreich
,
E Stirzaker
25   Deloitte, Canberra, Australien
,
S Vasudevan
26   Deloitte, Victoria, Australien
,
L Pezzulo
26   Deloitte, Victoria, Australien
,
V Ratziu
28   Sorbonne Université, Hôpital Pitié - Salpêtrière, Paris, Frankreich
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Background NASH is a chronic disease which can progress to end-stage liver disease (ESLD) if left untreated. There is a high risk of particularly rapid progression to ESLD in people with advanced liver fibrosis due to NASH, few of whom are diagnosed and under treater care in the EU5 countries. This study aims to estimate the prevalence of NASH and the socioeconomic burden associated with its treatment in the EU5 countries during 2018.

Methods The burden of NASH per country was estimated using cost-of-illness methodology applying a prevalence approach to estimate the number of adults with NASH in a base period, and the economic and wellbeing costs attributable to diagnosed NASH in that period. Wellbeing costs were estimated using the WHO burden of disease methodology, which includes societal wellbeing measures e.g. disability-adjusted life years (DALYs). The analysis was based on literature review and consultations with clinical experts, health economists and patient groups to reach consensus. Epidemiological data were derived from modelling studies (upper and lower bound). Resource-use estimates were based on literature and expert opinion to reflect current clinical practice. Unit costs were sourced from the literature and local fee schedules.

Results In the EU5 in 2018, only a small subset of adults living with any-stage NASH were diagnosed due to the low probability of being diagnosed at  <  F3 stage (where there is usually minimal symptomatology). Of the 0.9 - 2.0 million adults estimated to have advanced liver fibrosis due to NASH, only 37.8 - 39.1% were diagnosed. Direct costs due to NASH were estimated at €619 - 1,292 million/year; 95% of these costs were incurred from the diagnosis and monitoring of patients with advanced liver fibrosis due to NASH. Adults with NASH experienced between 311,944 and 660,451 DALYs. Total wellbeing costs ranged from €41,536 to 90,379 million, primarily driven by the high rate of premature mortality in patients with NASH.

Conclusions This study provides a realistic estimate of the number of adults diagnosed with any-stage NASH and under treater care in the EU5 in 2018. Prevention of progression to ESLD and appropriate management of adult NASH patients could result in reduced economic impact and improvements in wellbeing.



Publication History

Article published online:
08 September 2020

© Georg Thieme Verlag KG
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