Multinational study reveals the economic and social burden of NASH – a more serious form of non-alcohol related fatty liver disease

Posted on: 28th July 2020
  • Quality of life scores of NASH patients decreased with liver fibrosis (scarring) status (early vs advanced) in all countries
  • Economic cost of NASH in the UK estimated to be €4.8 (£4.2) billion annually

Results of a study of patients with Non-alcohol related steatohepatitis (NASH), has provided an insight into the economic and social burden of the disease in six countries, highlighting how urgent action is required to improve awareness and early diagnosis.

NASH is a progressive form of non-alcohol related fatty liver disease (NAFLD) which can lead to liver failure, liver cancer and liver transplantation.

The Global Assessment of the Impact of NASH (GAIN) study, which was undertaken by HCD Economics and the University of Chester in 2018, was published this month in JHEP Reports, a new online journal from the European Association for Study of Liver Disease.

3754 patients were enrolled in the study and data was collected to address the primary objective of the impact of NASH on patient’s quality of life and the secondary objective to estimate the total annual cost of the disease, including all health, non-health and indirect costs accruing to patients and their families.

The British Liver Trust welcomed the opportunity to become one of the contributing authors of the study.

Vanessa Hebditch, director of policy at the British Liver Trust said: “There has been scant research into the impact of NASH on patients’ quality of life, and on the direct and indirect costs of NASH to individuals and society. That is why we welcomed the GAIN study and have been pleased to be involved in the research with HCD Economics. We hope that this is the first step and that this research can be used to influence improved outcomes for NASH patients.

“We know that liver disease disproportionately affects the poorest and most vulnerable in society, and provision of care continues to be worse in the regions with the greatest deprivation.  Socio-economic research can help us highlight these discrepancies in diagnosis and care to support our work to improve outcomes for patients.”

The GAIN Study found that quality of life score significantly reduces as the disease progresses with individuals experiencing hepatic decompensation, characterised by jaundice, ascites, variceal haemorrhage, and encephalopathy.

In addition, the average NASH related costs were €2,763, €4,917 and €5,509 per patient for the direct medical, direct non-medical and indirect cost categories respectively. Further analysis to extrapolate NASH medical costs to national burden showed that costs could go from €2.6 billion in France to €4.8 billion in the UK to almost €80 billion in the US, which implies a significant and growing global public health concern.

Vanessa Hebditch says, “Experts predict that over the next decade non-alcohol related fatty liver disease will become the leading cause of liver disease in the UK. Addressing obesity is therefore vital if we are to reduce liver disease mortality. We work together as a key member of the Obesity Health Alliance to campaign for a number of policy interventions that will help address the wider environmental factors that lead to excess bodyweight, as well as the social inequality and cultural differences in overweight and obesity prevalence.”

Ideas for further analysis of the extensive data set now available to the GAIN team include understanding drivers of cost and outcomes and further work to better understand causality of poorer outcomes and higher patient costs.

Read more about the study here: