PGI27 THE BURDEN OF NON-ALCOHOLIC STEATOHEPATITIS (NASH) IN THE EU5 COUNTRIES

Abstract

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. 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. 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. 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.