OBJECTIVES: NASH is a chronic and progressive form of non-alcoholic fatty liver disease (NAFLD) leading to cirrhosis and hepatocellular carcinoma (HCC). NAFLD is associated with significant impairment in health-related quality of life (HRQoL), but the humanistic burden of NASH is still unclear. This review aimed to understand the evidence defining the impact of NASH on patients’ QoL.

METHODS: A structured literature review across multiple databases was conducted to investigate the QoL, patient reported outcomes (PRO) and productivity in NASH patients. Searches were restricted to publications reporting on NASH, English language and articles published between January 2009 and May 2019. A grey literature search was also conducted.

RESULTS: In total, only 13 publications were found reporting on the humanistic burden of NASH - the majority of studies demonstrated an impairment in HRQoL with poor physical and mental health across multiple PRO measures. No publications reported on the HRQoL in patients with early stages of NASH; however, four publications reported that NASH patients overall experience a range of symptoms, including pain, fatigue, anxiety and depression, and two publications reported a loss in productivity. A recent study showed that NASH patients with cirrhosis (F4) had lower physical health-related scores than with bridging fibrosis (F3) in all but one domain of CLDQ-NASH, SF-36, and EQ-5D HRQoL instruments (p≤0.01). Cirrhosis also poses a substantial emotional and financial burden to patients and caregivers, but not this has not been investigated specifically in NASH.

CONCLUSIONS: Overall, HRQoL is significantly impaired in NASH patients; however, there is a gap in the literature for HRQoL in NASH with early stages of fibrosis. Additionally, there is a lack of data on the wider humanistic burden of NASH, including loss of productivity, activities of daily living and caregiver burden, highlighting that further research is needed.