Commentary
Non-alcoholic steatohepatitis (NASH) leads to cirrhosis and is associated with a substantial socioeconomic burden, which, coupled with rising prevalence, is a growing public health challenge. Nevertheless, there has been little research into the socioeconomic burden associated with NASH.
Direct medical, direct non-medical and indirect costs resulting from NASH were captured in a real-world setting in the Global Assessment of the Impact of NASH (GAIN) study, a prevalence-based burden of illness study across Europe (France, Germany, Italy, Spain, and the UK) and the USA. Physicians provided demographic, clinical, and economic patient information via an online survey.
In total, 3,754 patients found to have NASH on liver biopsy were stratified by fibrosis score and by biomarkers as either early or advanced fibrosis. Per-patient costs were estimated using national unit price data and extrapolated to the population level to calculate the economic burden.
For 2018, the mean total annual per patient cost of NASH was € 2,763, € 4,917, and € 5,509 for direct medical, direct non-medical, and indirect costs, respectively. National per-patient cost was highest in the USA and lowest in France. As expected, costs increased with fibrosis and decompensation, driven by hospitalization and comorbidities. Indirect costs were driven by work loss. Extrapolating the per-patient cost to a population level demonstrates the rising prevalence of NASH and related comorbidities.
