The economic cost and health burden of non-alcoholic steatohepatitis (NASH) in the EU5 countries

J Schattenberg; P Newsome; L Serfaty; A Aghemo; S Augustin; E Tsochatzis; A Canbay; V de Ledinghen; E Bugianesi; M Romero-Gomez; S Ryder; H Bantel; J Boursier; S Petta; J Crespo; L Castera; V Leroy; C Le Pen; F-U Fricke; R Elliott; V Atella; J Mestre-Ferrandiz; L Floros; A Torbica; A Morgan; S Hartmanis; A Trylesinki; S Cure; E Stirzaker; S Vasudevan; L Pezzulo; V Ratziu

doi:10.1055/s-0040-1716199

Zeitschrift für Gastroenterologie, Inhaltsverzeichnis

Z Gastroenterol 2020; 58(08): e174-e175
DOI: 10.1055/s-0040-1716199

BEST Abstracts DGVS: Publikationen

The economic cost and health burden of non-alcoholic steatohepatitis (NASH) in the EU5 countries

Autor*innen

J Schattenberg

¹I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
P Newsome

²University of Birmingham, Birmingham, Vereinigtes Königreich
L Serfaty

³Hôpitaux Universitaires de Strasbourg, Strasbourg, Frankreich
A Aghemo

⁴Humanitas University and Humanitas Research Hospital IRCCS, Pieve Emanuele, Mailand, Italien
S Augustin

⁵Hospital Universitari Vall d’Hebron - Institut de Recerca, Barcelona, Spanien
E Tsochatzis

⁶UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, Vereinigtes Königreich
A Canbay

⁷Universitätsklinikum Magdeburg, Magdeburg, Deutschland
V de Ledinghen

⁸Centre Hospitalier Universitaire Bordeaux, Bordeaux, Frankreich
E Bugianesi

⁹University of Torino, Department of Medical Sciences, Turin, Italien
M Romero-Gomez

¹⁰Virgen del Rocío University Hospital, Sevilla, Spanien
S Ryder

¹¹Nottingham University Hospitals, Nottingham, Vereinigtes Königreich
H Bantel

¹²Klinik für Gastroenterologie, Hepatologie und Endokrinologie; Medizinische Hochschule Hannover, Hannover, Deutschland
J Boursier

¹³Angers University Hospital, Angers, Frankreich
S Petta

¹⁴Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italien
J Crespo

¹⁵Hospital Universitario Marqués de Valdecilla, Santander, Spanien
L Castera

¹⁶Université Paris-7, Department of Hepatology, Hôpital Beaujon, Paris, Frankreich
V Leroy

¹⁷Centre Hospitalier Universitaire de Grenoble, Grenoble, Frankreich
C Le Pen

¹⁸University Paris-Dauphine, Paris, Frankreich
F-U Fricke

¹⁹Technische Hochschule Nürnberg, Nürnberg, Deutschland
R Elliott

²⁰University of Manchester, Manchester, Vereinigtes Königreich
V Atella

²¹University Rome Tor Vergata, Rom, Italien
J Mestre-Ferrandiz

²²Independent Economics Consultant, Madrid, Spanien
L Floros

²³PHMR Limited, London, Vereinigtes Königreich
A Torbica

²⁴Bocconi University, Mailand, Italien
A Morgan

²⁵Deloitte, Canberra, Australien
S Hartmanis

²⁶Deloitte, Victoria, Australien
A Trylesinki

²⁷Intercept Pharmaceuticals, London, Vereinigtes Königreich
S Cure

²⁷Intercept Pharmaceuticals, London, Vereinigtes Königreich
E Stirzaker

²⁵Deloitte, Canberra, Australien
S Vasudevan

²⁶Deloitte, Victoria, Australien
L Pezzulo

²⁶Deloitte, Victoria, Australien
V Ratziu

²⁸Sorbonne Université, Hôpital Pitié - Salpêtrière, Paris, Frankreich

Abstract

Volltext

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.