Phisalprapa Pochamana, Prasitwarachot Ratthanon, Kositamongkol Chayanis, Hengswat Pranaidej, Srivanichakorn Weerachai, Washirasaksiri Chaiwat, Treeprasertsuk Sombat, Charatcharoenwitthaya Phunchai, Chaiyakunapruk Nathorn
Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Pharmacy Technicians, Sirindhorn College of Public Health Suphanburi, Suphanburi, Thailand.
BMC Gastroenterol. 2021 Mar 25;21(1):135. doi: 10.1186/s12876-021-01720-w.
Non-alcoholic steatohepatitis (NASH) has been recognised as a significant form of chronic liver disease and a common cause of cirrhosis and hepatocellular carcinoma, resulting in a considerable financial burden on healthcare resources. Currently, there is no information regarding the economic burden of NASH in low- and middle-income countries (LMICs). The aim of this study was to estimate the economic burden of NASH in Thailand as a lesson learned for LMICs.
To estimate the healthcare costs and prevalence of NASH with significant fibrosis (fibrosis stage ≥ 2) in the general Thai population, an eleven-state lifetime horizon Markov model with 1-year cycle length was performed. The model comprised Thai population aged 18 years and older. The cohort size was based on Thailand Official Statistic Registration Systems. The incidence of NASH, transitional probabilities, and costs-of-illness were based on previously published literature, including systematic reviews and meta-analyses. The age-specific prevalence of NASH was based on Thai NASH registry data. Costs were expressed in 2019 US Dollars ($). As we undertook analysis from the payer perspective, only direct medical costs were included. All future costs were discounted at an annual rate of 3%. A series of sensitivity analyses were performed.
The estimated total number of patients with significant NASH was 2.9 million cases in 2019, based on a NASH prevalence of 5.74%. The total lifetime cost of significant NASH was $15.2 billion ($5,147 per case), representing approximately 3% of the 2019 GDP of Thailand. The probabilistic sensitivity analysis showed that the lifetime costs of significant NASH varied from $11.4 billion to $18.2 billion.
The economic burden associated with NASH is substantial in Thailand. This prompts clinicians and policy makers to consider strategies for NASH prevention and management.
非酒精性脂肪性肝炎（NASH）已被公认为慢性肝病的一种重要形式，是肝硬化和肝细胞癌的常见病因，给医疗资源带来了相当大的经济负担。目前，关于低收入和中等收入国家（LMICs）NASH的经济负担尚无相关信息。本研究的目的是估计泰国NASH的经济负担，为LMICs提供经验教训。
为了估计泰国普通人群中伴有显著纤维化（纤维化分期≥2）的NASH的医疗费用和患病率，构建了一个周期长度为1年的11状态终身马尔可夫模型。该模型涵盖18岁及以上的泰国人群。队列规模基于泰国官方统计登记系统。NASH的发病率、转移概率和疾病成本基于先前发表的文献，包括系统评价和荟萃分析。NASH的年龄特异性患病率基于泰国NASH登记数据。成本以2019年美元（$）表示。由于我们从支付方角度进行分析，仅纳入直接医疗成本。所有未来成本按3%的年利率进行贴现。进行了一系列敏感性分析。
基于5.74%的NASH患病率，2019年估计伴有显著NASH的患者总数为290万例。伴有显著NASH的终身总成本为152亿美元（每例5147美元），约占泰国2019年国内生产总值的3%。概率敏感性分析表明，伴有显著NASH的终身成本在114亿美元至182亿美元之间。
在泰国，与NASH相关的经济负担巨大。这促使临床医生和政策制定者考虑NASH的预防和管理策略。
