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. 2021 Mar 25;21(1):135.
doi: 10.1186/s12876-021-01720-w.

Economic burden of non-alcoholic steatohepatitis with significant fibrosis in Thailand

Pochamana Phisalprapa  1 , Ratthanon Prasitwarachot  2 , Chayanis Kositamongkol  1 , Pranaidej Hengswat  3 , Weerachai Srivanichakorn  1 , Chaiwat Washirasaksiri  1 , Sombat Treeprasertsuk  4 , Phunchai Charatcharoenwitthaya  5 , Nathorn Chaiyakunapruk  6
Affiliations

Economic burden of non-alcoholic steatohepatitis with significant fibrosis in Thailand

Pochamana Phisalprapa et al. BMC Gastroenterol. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: The economic burden associated with NASH is substantial in Thailand. This prompts clinicians and policy makers to consider strategies for NASH prevention and management.

Keywords: Cost of illness; Economic burden; NASH; Non-alcoholic steatohepatitis; Prevalence; Significant fibrosis; Thailand.

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Conflict of interest statement

Nathorn Chaiyakunapruk received an honorarium as advisory board for Intercept. All other authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
A Markov model of non-alcoholic fatty liver disease. CC compensated cirrhosis, DC decompensated cirrhosis, F0 fibrosis stage 0/ no fibrosis, F1 fibrosis stage 1, F2 fibrosis stage 2, F3 fibrosis stage 3, F4 fibrosis stage 4, HCC hepatocellular carcinoma, LT liver transplantation, Post-LT post-liver transplantation, TP transitional probability
Fig. 2
Fig. 2
Probabilistic sensitivity analysis (PSA). PSA represented by box plots showing the median, 25th percentile, 75th percentile, and outlier cost of NASH with significant fibrosis of each age group (2019 $) (a) total lifetime costs (b) lifetime cost per case
See this image and copyright information in PMC

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