OBJECTIVES: Non-alcoholic steatohepatitis (NASH) is associated with increased risk of cirrhosis, hepatocellular carcinoma, cardiovascular disease, and type 2 diabetes, but evidence on both healthcare and societal burden of NASH is lacking. The present study examined healthcare and societal costs related to patients with non-alcoholic fatty liver disease (NAFLD), including NASH.

METHODS: We used real-world data from the comprehensive nationwide Danish registries to identify all patients with a hospital diagnosis and biopsy-confirmed NAFLD (≥18 years) from 1997–2021. Patients were classified as having non-cirrhotic NASH (with or without fibrosis), simple steatosis or cirrhosis. All patient groups were matched 1:5 with liver-disease free reference groups. Healthcare and homecare costs, production loss, sick leave, unemployment and early retirement were investigated 5 years before diagnosis until 11 years after, i.e. 16 years. Healthcare and societal excess costs due to NASH/NAFLD were calculated as the difference between patients and the matching reference group.

RESULTS: 3,712 NAFLD patients were identified (NASH=1,030; simple steatosis=1,540 and cirrhosis=1,142). Highest average total healthcare costs were found in the year leading up to diagnosis: cirrhosis €12,949 (6.2-fold higher than reference group), NASH € 6,318 (4.1-fold higher) and simple steatosis € 4,716 (3.1-fold higher). For cirrhosis patients, inpatient contacts accounted for 68% of the excess costs, whereas outpatient contacts accounted for 49% of NASH patients’ costs. Excess costs of NASH in the years after diagnosis were around 70% of excess costs in the year leading up to diagnosis. NASH patients’ income was statistically significantly lower than the reference groups’ income. Higher risk of early retirement due to disability was also found (HR: 4.37; 95% CI: 3.17–6.02).

CONCLUSIONS: The burden on society caused by NASH/NAFLD was considerable, even for the early stages of the disease. Moreover, patients experienced adverse effects with reduced incomes as well as early retirement due to disability.