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Review
. 2021 Jun;41(6):1227-1242.
doi: 10.1111/liv.14825. Epub 2021 Mar 18.

Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis in five European countries in 2018: A cost-of-illness analysis

Jörn M Schattenberg  1 , Jeffrey V Lazarus  2 , Philip N Newsome  3   4   5 , Lawrence Serfaty  6 , Alessio Aghemo  7 , Salvador Augustin  8 , Emmanuel Tsochatzis  9 , Victor de Ledinghen  10 , Elisabetta Bugianesi  11 , Manuel Romero-Gomez  12 , Heike Bantel  13 , Stephen D Ryder  14 , Jerome Boursier  15 , Vincent Leroy  16 , Javier Crespo  17 , Laurent Castera  18 , Lefteris Floros  19 , Vincenzo Atella  20 , Jorge Mestre-Ferrandiz  21 , Rachel Elliott  22 , Achim Kautz  23 , Alice Morgan  24 , Sally L Sansom  25 , Sharad Vasudevan  25 , Lynne Pezzullo  24 , Aldo Trylesinski  26 , Sandrine Cure  26 , Victoria Higgins  27 , Vlad Ratziu  28
Affiliations
Review

Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis in five European countries in 2018: A cost-of-illness analysis

Jörn M Schattenberg et al. Liver Int. 2021 Jun.

Abstract

Background and aims: Non-alcoholic steatohepatitis (NASH) is a chronic disease that can progress to end-stage liver disease (ESLD). A large proportion of early-stage NASH patients remain undiagnosed compared to those with advanced fibrosis, who are more likely to receive disease management interventions. This study estimated the disease burden and economic impact of diagnosed NASH in the adult population of France, Germany, Italy, Spain and the United Kingdom in 2018.

Methods: The socioeconomic burden of diagnosed NASH was estimated using cost-of-illness methodology applying a prevalence approach to estimate the number of adults with NASH and the attributable economic and wellbeing costs. Given undiagnosed patients do not incur costs in the study, the probability of diagnosis is central to cost estimation. The analysis was based on a literature review, databases and consultation with clinical experts, economists and patient groups.

Results: The proportion of adult NASH patients with a diagnosis ranged from 11.9% to 12.7% across countries, which increased to 38.8%-39.1% for advanced fibrosis (F3-F4 compensated cirrhosis). Total economic costs were €8548-19 546M. Of these, health system costs were €619-1292M. Total wellbeing costs were €41 536-90 379M. The majority of the undiagnosed population (87.3%-88.2% of total prevalence) was found to have early-stage NASH, which, left untreated, may progress to more resource consuming ESLD over time.

Conclusions: This study found that the majority of economic and wellbeing costs of NASH are experienced in late disease stages. Earlier diagnosis and care of NASH patients could reduce future healthcare costs.

Keywords: burden of disease; cost-of-illness analysis; economic impact; healthcare resource utilisation; non-alcoholic steatohepatitis (NASH).

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Conflict of interest statement

Alice Morgan, Sally L Sansom, Sharad Vasudevan and Lynne Pezzullo have received funding from Intercept Pharmaceuticals for consulting services. Jörn Schattenberg reports grants and personal fees from Gilead Sciences; and personal fees from Genfit, Intercept Pharmaceuticals, IQVIA, Novartis, Roche, Bristol‐Myers Squibb and Echosens, outside the submitted work. Jeffrey Lazarus reports personal fees from CEPHEID, GSK and Janssen; grants, personal fees and other from Abbvie and Gilead Sciences; and grants and personal fees from MSD, outside the submitted work. Philip N Newsome reports grants from Novo Nordisk and Boehringer Ingelheim; and other fees from Novo Nordisk, Pfizer, Boehringer Ingelheim, Intercept Pharmaceuticals, Gilead Sciences and Poxel Pharmaceuticals, outside the submitted work. Philip N Newsome is also supported by the National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. The views expressed are those of the author and not necessarily those of the NIHR, the Department of Health and Social Care or the NHS. Lawrence Serfaty reports grants and personal fees from Gilead Sciences; and personal fees from Intercept Pharmaceuticals, AbbVie, Novartis and Pfizer, outside the submitted work. Alessio Aghemo reports grant and research support from AbbVie and Gilead Sciences; and personal fees from MSD, Intercept Pharmaceuticals and AlfaSigma, outside the submitted work. Salvador Augustin reports personal fees from Intercept Pharmaceuticals as part of the submitted work. Salvador Augustin also reports grants and personal fees from Gilead Sciences; and personal fees from Novartis, Pfizer, IQVIA and Allergan, outside the submitted work. Emmanuel Tsochatzis reports personal fees from Intercept Pharmaceuticals, Gilead Sciences and Pfizer, outside the submitted work. Victor de Ledinghen reports grants and non‐financial support from Gilead, AbbVie and Intercept Pharmaceuticals; and personal fees from Gilead, AbbVie, Intercept Pharmaceuticals, Echosens, Supersonic Image, Pfizer, Medac, Indivior, Spimaco, BMS, Bayer and MSD, outside the submitted work. Elisabetta Bugianesi has no conflicts of interest to disclose. Manuel Romero‐Gomez reports grants from AbbVie, Gilead Sciences and Intercept Pharmaceuticals; is a speaker for Gilead Sciences, Intercept Pharmaceuticals, Novo Nordisk, Novartis and Shionogi; is a scientific advisor for Gilead Sciences, Intercept Pharmaceuticals, Novo Nordisk, Prosciento, Kaleido, Boehringer Ingelheim, BMS, Shionogi and Allergan; and is co‐owner of DeMILI, outside the submitted work. Heike Bantel reports personal fees from Intercept Pharmaceuticals, outside the submitted work. Stephen Ryder has attended advisory boards and acted as a paid speaker for Intercept Pharmaceuticals, outside the submitted work. Jerome Boursier has no conflicts of interest to disclose. Javier Crespo reports grant, consultancy and lecture fees from AbbVie, Gilead Sciences, Intercept Pharmaceuticals and MSD. Laurent Castera reports personal fees from AbbVie, Allergan, Echosens, Gilead Sciences, Intercept Pharmaceuticals, Merck, Novo Nordisk, Pfizer and Servier as part of the submitted work. Lefteris Floros has no conflicts of interests to report. Vincenzo Atella has no conflicts of interest to disclose. Jorge Mestre‐Ferrandiz reports personal fees form Intercept Pharmaceuticals as part of the submitted work. Rachel Elliot has no conflicts of interest to disclose. Achim Kautz has no conflicts of interest to disclose. Vlad Ratziu reports other fees from Intercept Pharmaceuticals, outside the submitted work. Victoria Higgins is an employee of Adelphi Real World who have received funding from Intercept Pharmaceuticals for access to the Adelphi NASH DSP data. Aldo Tyrelsinski and Sandrine Cure have received consultancy fees from, and are current employees of, Intercept Pharmaceuticals.

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