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The Economic Burden of Non-Alcoholic Steatohepatitis: A Systematic Review

Author

Listed:
  • Michal Witkowski

    (DRG Abacus (Clarivate))

  • Søren Ilsøe Moreno

    (Novo Nordisk A/S)

  • João Fernandes

    (Novo Nordisk A/S)

  • Pierre Johansen

    (Novo Nordisk Denmark A/S, Region North & West Europe)

  • Margarida Augusto

    (Novo Nordisk A/S)

  • Sunita Nair

    (DRG Abacus (Clarivate))

Abstract

Background The global prevalence of non-alcoholic steatohepatitis (NASH) is increasing, such that NASH is predicted to become the leading cause of liver transplantation (LT) in the US by 2025. Despite this, data on the economic burden of NASH are limited. Objectives This systematic literature review aimed to summarise and critically evaluate studies reporting on the economic burden of NASH and identify evidence gaps for subsequent research. Methods Medline, EMBASE, the Cochrane Library and EconLit were searched up to 6 January 2021 for English language articles published from January 2010 to January 2021 inclusive that reported economic outcomes of a NASH population or subpopulation. Evidence was presented and synthesised using narrative data analysis, and quality was assessed by two reviewers using an 11-item checklist developed for economic evaluations and adapted to cost of illness. Results Fourteen studies were included, of which five presented data on costs and resource use, four on costs only and five on resource use only. Overall, NASH is associated with a significant and increasing economic burden in terms of healthcare resource utilisation (HCRU) and direct and indirect costs. This burden was higher among NASH patients with advanced (fibrosis stage 3–4) versus early (fibrosis stage 0–2) disease, symptomatic versus asymptomatic disease and for patients with complications or comorbidities versus those without. In LT patients, those with NASH as the primary indication had greater HCRU and higher costs compared with non-NASH indications such as hepatitis B and C viruses. Considerable variability in HCRU and costs was seen across the US and Europe, with the highest costs seen in the US. The quality of the included studies was variable, and the studies themselves were heterogeneous in terms of study methodology, patient populations, comorbidities, follow-up time and outcomes measured. Conclusions This review highlights a general scarcity of NASH-specific economic outcomes data. Despite this, the identified studies show that NASH is associated with a significant economic burden in terms of increased HCRU, and high direct medical and non-medical costs and societal burden that increases with disease severity or when patients have complications or comorbidity. More national-level NASH prevalence data are needed to generate accurate forecasts of HCRU and costs in the coming decades. Funding Novo Nordisk A/S, Søborg, Denmark. Video Abstract The economic burden of non-alcoholic steatohepatitis: a video abstract (MP4 12242 KB)

Suggested Citation

  • Michal Witkowski & Søren Ilsøe Moreno & João Fernandes & Pierre Johansen & Margarida Augusto & Sunita Nair, 2022. "The Economic Burden of Non-Alcoholic Steatohepatitis: A Systematic Review," PharmacoEconomics, Springer, vol. 40(8), pages 751-776, August.
    • Handle: RePEc:spr:pharme:v:40:y:2022:i:8:d:10.1007_s40273-022-01140-y
    DOI: 10.1007/s40273-022-01140-y
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
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