WHAT ARE THE OUTCOMES OF NASH?

The more serious NASH becomes, the more difficult it is to manage.¹ Studies report that some patients with NASH experience pain, fatigue, and a generally lower quality of life compared to others.² In addition, NASH patients with fibrosis have a higher risk of progression to cirrhosis, end-stage liver disease, and hepatocellular carcinoma.¹
But NASH can be reversible.³ Therefore, it is critical to resolve NASH in patients with fibrosis before it has a chance to progress to life-threatening stages.

HIGHER CARDIOVASCULAR MORTALITY

NAFLD patients are at higher risk of cardiovascular events. In fact, one study found that cardiovascular disease was the most common cause of death in NAFLD patients (38% of cases), before non-liver cancer (19%) and cirrhosis-related complications (8%).⁴

HIGHER LIVER-RELATED MORTALITY

Liver diseases, including complications due to cirrhosis, infections, or other issues, are the third most common cause of mortality in NAFLD patients, after cardiovascular disease and non-liver cancer.⁴

Thus, liver transplant is commonly indicated for NASH patients with end-stage liver disease.¹ But liver transplant is obviously a complex and risky surgical procedure. Even if a donor is available, many patients may not be eligible for a transplant due to complications related to a deteriorated liver state.

BURDEN FOR SOCIETIES

Without approved medication to treat the disease, NASH is a growing economical and societal concern for many countries. In 2017, the total cost for a liver transplant in the United States was estimated at US $812,500 per patient (around €681,000) versus US $740,000 in 2014 and US $577,000 in 2011.^5-7

In Italy, France, Germany, and the United Kingdom, the total annual cost of NAFLD patient care is estimated at 35 billion euros per year and could represent an economic burden estimated at 302 billion euros in as little as 10 years.⁸

NASH is also associated with higher risk of cardiovascular disease,⁹ and is increasing global healthcare spending and pressure on healthcare systems.^5,10

Finally, NASH can result in irreversible deterioration of quality of life for individuals, ranging from fatigue to severe clinical symptoms, impacting working individuals’ and societies’ productivity.²

HOW IS NASH TREATED?

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References

1. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol, 2016;64(6):1388-1402.
2. Kennedy-Martin T, Bae JP, Paczkowski R, et al. Health-related quality of life burden of nonalcoholic steatohepatitis: a robust pragmatic literature review. J Patient Rep Outcomes. 2018;2:1-14.
3. Rinella ME, Sanyal AJ. Management of NAFLD: a stage-based approach. Nature. 2016;13:196-205.
4. Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, associates with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149(2):389-397.
5. Bentley TS, Phillips SJ. Milliman Research Report, 2017 U.S. organ and tissue transplant cost estimates and discussion. http://www.milliman.com/uploadedFiles/insight/2017/2017-Transplant-Report.pdf. Published August 2017. Accessed October 8, 2019.
6. Bentley TS. Milliman Research Report, 2014 U.S. organ and tissue transplant cost estimates and discussion. http://www.milliman.com/insight/research/health/2014-U_S_-organ-and-tissue-transplant-cost-estimates-and-discussion/. Published December 2014. Accessed October 10, 2019.
7. Bentley TS, Hanson SG. Milliman Research Report, 2011 U.S. organ and tissue transplant cost estimates and discussion. http://us.milliman.com/uploadedFiles/insight/research/health-rr/2011-us-organ-tissue.pdf. Published April 2011. Accessed October 10, 2019.
8. Younossi ZM, Blissett D, Bilissett R, et al. The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe. Hepatology, 2016;64(5):1577-1586.
9. Younossi, ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease -Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73-84.
10. Estes, C, Razavi H, Loomba R, et al. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-133.