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. 2023 May-Jun;13(3):454-467.
doi: 10.1016/j.jceh.2022.12.005. Epub 2022 Dec 22.

The Growing Economic and Clinical Burden of Nonalcoholic Steatohepatitis (NASH) in the United States

Zobair M Younossi  1   2   3 , James M Paik  1   2   3 , Linda Henry  3 , Joe Yang  4 , Gail Fernandes  4 , Maria Stepanova  3   5 , Fatema Nader  5
Affiliations

The Growing Economic and Clinical Burden of Nonalcoholic Steatohepatitis (NASH) in the United States

Zobair M Younossi et al. J Clin Exp Hepatol. 2023 May-Jun.

Abstract

Background: Nonalcoholic steatohepatitis (NASH) is a cause of chronic liver disease.

Aim: Model the burden of NASH in the United States according to obesity.

Methods: The discrete-time Markov model comprised adult NASH subjects moving through 9 health states and 3 absorbing death states (liver, cardiac, and other deaths) with 1-year cycles and a 20-year horizon. Given that reliable natural history data for NASH are not available, transition probabilities were estimated from the literature and population-based data. These rates were disaggregated to determine age-obesity group rates by applying estimated age-obesity patterns. The model considers 2019 prevalent NASH cases and new incident NASH cases (2020-2039), assuming that recent trends will continue. Annual per-patient costs by health state were based on published data. Costs were standardized to 2019 US dollars and inflated by 3% annually.

Results: NASH cases in the United States are forecasted to increase by +82.6%, from 11.61 million (2020) to 19.53 million (2039). During the same period, cases of advanced liver disease increased +77.9%, from 1.51 million to 2.67 million, while its proportion remained stable (13.46%-13.05%). Similar patterns were observed in both obese and non-obese NASH. Among NASH, 18.71 million overall deaths, 6.72 million cardiac-specific deaths, and 1.71 million liver-specific deaths were observed by 2039. During this period, the projected cumulative direct healthcare costs were $1208.47 billion (obese NASH) and $453.88 billion (non-obese NASH). By 2039, the projected NASH attributable healthcare cost per patient increased from $3636 to $6968.

Conclusions: There is a substantial and growing clinical and economic burden of NASH in the United States.

Keywords: GBD; NAFLD; NHANES; age group; obesity.

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Figures

Figure 1
Figure 1
9 Health states and 3 absorbing death states for NASH.
Figure 2
Figure 2
A methodological summary for transition probabilities. TP, Transition probability.
Figure 3
Figure 3
Projected prevalent NASH cases by the presence of obesity in the United States (2020–2039).
Figure 4
Figure 4
Cumulative projected deaths among NASH population in the United States for the next two decades.
Figure 5
Figure 5
Economic burden of NASH in the United States for the next two decades.
See this image and copyright information in PMC

References

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