THE BURDEN OF NON-ALCOHOLIC STEATOHEPATITIS (NASH) IN THE EU5 COUNTRIES

Author(s)

Le Pen C¹, Fricke FU², Newsome P³, Schattenberg JM⁴, Serfaty L⁵, Aghemo A⁶, Augustin S⁷, Tsochatzis E⁸, Canbay A⁹, de Lédinghen V¹⁰, Bugianesi E¹¹, Romero-Gomez M¹², Ryder S¹³, Bantel H¹⁴, Boursier J¹⁵, Petta S¹⁶, Crespo J¹⁷, Castera L¹⁸, Leroy V¹⁹, Elliott RA²⁰, Atella V²¹, Mestre-Ferrandiz J²², Floros L²³, Torbica A²⁴, Morgan A²⁵, Hartmanis S²⁶, Trylesinski A²⁷, Cure S²⁷, Stirzaker E²⁵, Vasudevan S²⁶, Pezzullo L²⁵, Ratziu V²⁸
¹University Paris-Dauphine, Paris, France, ²Technische Hochschule Nürnberg, Nürnberg, Germany, ³University of Birmingham, Birmingham, UK, ⁴University Medical Center Mainz, Mainz, Germany, ⁵Hôpitaux Universitaires de Strasbourg, Strasbourg, France, ⁶Humanitas University and Humanitas Research Hospital IRCCS, Milano, Italy, ⁷Hospital Universitari Vall d'Hebron, Barcelona, Spain, ⁸Royal Free Hospital, London, UK, ⁹Universitätsklinikum Magdeburg, Magdeburg, Germany, ¹⁰Centre Hospitalier Universitaire Bordeaux, Bordeaux, France, ¹¹University of Torino, Torino, Italy, ¹²Virgen del Rocío University Hospital, Sevilla, Spain, ¹³Nottingham University Hospitals, Nottingham, UK, ¹⁴Medizinische Hochschule Hannover, Hannover, Germany, ¹⁵Angers University Hospital, Angers, France, ¹⁶University of Palermo, Palermo, Italy, ¹⁷Hospital Universitario Marqués de Valdecilla, Santander, Spain, ¹⁸Hôpital Beaujon, Paris, France, ¹⁹Centre Hospitalier Universitaire de Grenoble, Grenoble, France, ²⁰Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK, ²¹University Rome Tor Vergata, Rome, Italy, ²²Independent Economics Consultant, Madrid, Spain, ²³PHMR Limited, London, UK, ²⁴SDA Bocconi School of Management, Milan, MI, Italy, ²⁵Deloitte, Canberra, Australia, ²⁶Deloitte, Victoria, Australia, ²⁷Intercept Pharmaceuticals, London, UK, ²⁸Hôpital Pitié-Salpêtrière, Paris, France

OBJECTIVES : NASH is a chronic disease that can progress to end-stage liver disease. This progression is particularly rapid in NASH patients with advanced liver fibrosis (stages F3–F4). This study estimated the disease burden and economic impact of NASH in the adult population of France, Germany, Italy, Spain and the UK.

METHODS : A cost-of-illness methodology applying a prevalence approach was used to estimate the number of adults with NASH (stages F0–F4, hepatocellular carcinoma and liver transplant) in 2018, and the attributable economic and wellbeing costs. Wellbeing costs were estimated using World Health Organisation burden of disease methodology. The analysis and resource-use were based on extensive literature review, and consultation with clinical experts, health economists and patient groups. Epidemiological estimates were derived from two modelling studies (upper and lower bound). Costs were sourced from literature and local fee schedules.

RESULTS : The estimated prevalence of NASH ranged from 1.89% to 4.03% across F0–F4 patients. Patients with advanced fibrosis due to NASH (F3–F4) were estimated to range from 0.37% to 0.79% or 0.9–2.0 million adults; of these, only 37.8–39.1% were diagnosed. The proportion of patients with advanced fibrosis due to NASH and a diagnosis therefore comprised between 0.15% and 0.33%. Total economic costs in the EU5 ranged between €6,065 and €13,424 million; of these, direct health system costs ranged from €619 to €1,292 million. Total wellbeing costs ranged from €41,536 to €90,379 million, primarily driven by the high mortality rate of NASH patients.

CONCLUSIONS : This study found that there was a low rate of diagnosis of advanced liver fibrosis due to NASH in the EU5 countries. There was also a notable variation between the countries in the prevalence of all-stage NASH and its associated economic costs.

Conference/Value in Health Info

2019-11, ISPOR Europe 2019, Copenhagen, Denmark

Code

PGI27

Topic

Economic Evaluation, Epidemiology & Public Health, Methodological & Statistical Research

Topic Subcategory

Modeling and simulation

Disease

Gastrointestinal Disorders

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