DRG Abacus (Clarivate), Bicester, UK.
Novo Nordisk A/S, Søborg, Denmark.
Pharmacoeconomics. 2022 Aug;40(8):751-776. doi: 10.1007/s40273-022-01140-y. Epub 2022 Jul 5.
The global prevalence of non-alcoholic steatohepatitis (NASH) is increasing, such that NASH is predicted to become the leading cause of liver transplantation (LT) in the US by 2025. Despite this, data on the economic burden of NASH are limited.
This systematic literature review aimed to summarise and critically evaluate studies reporting on the economic burden of NASH and identify evidence gaps for subsequent research.
Medline, EMBASE, the Cochrane Library and EconLit were searched up to 6 January 2021 for English language articles published from January 2010 to January 2021 inclusive that reported economic outcomes of a NASH population or subpopulation. Evidence was presented and synthesised using narrative data analysis, and quality was assessed by two reviewers using an 11-item checklist developed for economic evaluations and adapted to cost of illness.
Fourteen studies were included, of which five presented data on costs and resource use, four on costs only and five on resource use only. Overall, NASH is associated with a significant and increasing economic burden in terms of healthcare resource utilisation (HCRU) and direct and indirect costs. This burden was higher among NASH patients with advanced (fibrosis stage 3-4) versus early (fibrosis stage 0-2) disease, symptomatic versus asymptomatic disease and for patients with complications or comorbidities versus those without. In LT patients, those with NASH as the primary indication had greater HCRU and higher costs compared with non-NASH indications such as hepatitis B and C viruses. Considerable variability in HCRU and costs was seen across the US and Europe, with the highest costs seen in the US. The quality of the included studies was variable, and the studies themselves were heterogeneous in terms of study methodology, patient populations, comorbidities, follow-up time and outcomes measured.
This review highlights a general scarcity of NASH-specific economic outcomes data. Despite this, the identified studies show that NASH is associated with a significant economic burden in terms of increased HCRU, and high direct medical and non-medical costs and societal burden that increases with disease severity or when patients have complications or comorbidity. More national-level NASH prevalence data are needed to generate accurate forecasts of HCRU and costs in the coming decades.
Novo Nordisk A/S, Søborg, Denmark.
非酒精性脂肪性肝炎（NASH）的全球患病率正在上升，预计到 2025 年，NASH 将成为美国肝移植（LT）的主要原因。尽管如此，关于 NASH 经济负担的数据仍然有限。
本系统文献综述旨在总结和批判性评估报告 NASH 经济负担的研究，并确定后续研究的证据空白。
截至 2021 年 1 月 6 日，检索了 Medline、EMBASE、Cochrane 图书馆和 EconLit，以获取 2010 年 1 月至 2021 年 1 月期间发表的英文文章，这些文章报告了 NASH 人群或亚人群的经济结果。使用叙述性数据分析呈现和综合证据，并使用为经济评估制定的 11 项检查表，由两名审阅者评估质量，并针对疾病成本进行了调整。
纳入了 14 项研究，其中 5 项研究报告了成本和资源利用情况，4 项研究仅报告了成本，5 项研究仅报告了资源利用情况。总体而言，NASH 在医疗资源利用（HCRU）和直接及间接成本方面存在显著且不断增加的经济负担。与早期（纤维化分期 0-2）疾病相比，晚期（纤维化分期 3-4）疾病、有症状与无症状疾病以及有并发症或合并症的患者的负担更高。在 LT 患者中，NASH 作为主要指征的患者与非 NASH 指征（如乙型肝炎和丙型肝炎病毒）相比，HCRU 更高，成本更高。在美国和欧洲，HCRU 和成本的差异很大，美国的成本最高。纳入研究的质量参差不齐，研究本身在研究方法、患者人群、合并症、随访时间和测量的结果方面存在异质性。
本综述强调了 NASH 特定经济结果数据普遍缺乏的问题。尽管如此，已确定的研究表明，NASH 与 HCRU 增加、直接医疗和非医疗成本高以及疾病严重程度或患者出现并发症或合并症时社会负担增加有关，这与显著的经济负担有关。需要更多的全国性 NASH 流行数据来预测未来几十年的 HCRU 和成本。
丹麦索伯格的诺和诺德公司。
