OBJECTIVES : Nonalcoholic steatohepatitis (NASH) is the progressive form of nonalcoholic fatty liver disease (NAFLD) with higher risk of mortality and morbidity. There are about 33 million NASH patients in China in 2016 and this could bring a great burden to the society with the disease progression. The aim of this study was to estimate the total economic burden of NASH and advanced NASH in China.

METHODS : A Markov model was built to estimate the economic burden consisting all stages of NASH and advanced NASH including liver fibrosis, cirrhosis, liver cancer and death. The time horizon was 50 years with 1-year cycle for each transition. The model was built from a society perspective, and the costs included direct medical costs and indirect costs. Epidemiology data and disease progression rate for status transition were obtained from published literature. Diagnose rate, treatment rate, annual medical visits for each status and medical costs were collected from expert interviews. Direct medical costs were assessed by multiplying the annual medical visits by the medical costs per visit. Indirect costs were converted through the human capital method. All future costs were discounted at an annual rate of 5%.

RESULTS : There will be 37.5 million NASH patients in China in 2021. In the next 5, 10, 20 and 50 years, the economic burden of all NASH patients will be ￥0.7 trillion, ￥3.2 trillion, ￥7.4 trillion and ￥13.1 trillion, among which the economic burden caused by advanced NASH accounts for 58.9%, 85.1%, 88.9% and 89.1%, respectively.

CONCLUSIONS : In the next 50 years, the economic burden of NASH will increase rapidly, with a large percentage on the advanced NASH. Therefore, it is highly important to improve the rate of clinical screening and intervention as well as new drug development to prevent disease progression and then reduce the economic burden.