The Clinical and Economic Burden of Nonalcoholic Steatohepatitis
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FATTY LIVER DISEASE (Z YOUNOSSI, SECTION EDITOR)
The Clinical and Economic Burden of Nonalcoholic Steatohepatitis Brian Lam 1,2 & Kyle Kurzke 1,2 & Zobair Younossi 1,2 Published online: 19 September 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Purpose of review Nonalcoholic fatty liver disease (NAFLD) will be the dominant and most impactful liver disease for the next generation. As the obesity and diabetes epidemic continues and the general populations in most industrialized countries become older, NAFLD and its progressive subtype nonalcoholic steatohepatitis (NASH) will have a significant clinical and economic impact on society, both in the USA and globally. This manuscript provides a review of recently published articles that detail the impact of NAFLD and NASH. Recent findings Overall, the literature shows that NAFLD is the most common liver disease globally, and that NASH is poised to become one of the dominant drivers of cirrhosis and hepatocellular carcinoma. Decompensated cirrhosis due to NASH will soon be the leading indication for liver transplantation. Costs increase significantly as patients progress to later stages of liver disease. Overall, the annual direct medical costs related to NAFLD are estimated to be near $100 billion in the USA and over €35 billion in Europe. The price tag almost triples if indirect costs are included. The global impact of NAFLD and NASH is projected to increase, with a 178% increase in liver-related deaths by 2030. Summary The clinical and economic impact of NAFLD and NASH will be immense in the upcoming decades. This highlights the great need for better screening, surveillance, linkage to care, risk stratification, and treatment options. Keywords Economic burden . HEOR . NASH . Steatohepatitis . NAFLD . Cost analysis
Introduction and Epidemiology Over the next decades, nonalcoholic fatty liver disease (NAFLD) is poised to be the liver disease that will have the greatest clinical and economic impact. The majority of the liverrelated burden will be in patients with nonalcoholic steatohepatitis (NASH), which is the histologic subtype of NAFLD that has the potential to progress to advanced fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). As many westernized and industrialized societies age and as the obesity and diabetes epidemic grows, the burden associated with NAFLD and NASH is only expected to increase. Therefore, in this
This article is part of the Topical Collection on Fatty Liver Disease * Zobair Younossi [email protected] 1
Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
2
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
review, the impact of NAFLD and NASH, especially as detailed in more recent analysis, will be summarized. The epidemiology of NAFLD and NASH has been well described. A recent systematic review estimates that the global prevalence of NAFLD is 25.4%, with variation in prevalenc
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