Modelling the Economic and Clinical Burden of Non-Alcoholic Steatohepatitis in East Asia: Data from Hong Kong.

BACKGROUND Non-alcoholic steatohepatitis (NASH) is the progressive form of non-alcoholic fatty liver disease (NAFLD) and prevalence is rising in Asia due to increases rates of urbanization, sedentary lifestyles, and poor nutrition. METHODS We built a Markov model with 20-year horizon to estimate the burden of NASH in Hong Kong. Cohort size was determined by population size, prevalence of NAFLD, and incidence of NASH in 2017. Health states include hepatic steatosis (NAFL), fibrosis stages 0-3, compensated and decompensated cirrhosis, hepatocellular carcinoma (HCC), post-LT, and liver-related, cardiovascular, and background mortality. Transition probabilities were estimated from literature and we converted 2017 Gazette price from the Hospital Authority of Hong Kong to US dollars. We discounted costs by 3% annually. Health utilities were assumed to be the same as in the US. RESULTS NASH will cost $1.32 billion and 124 liver transplants over 20 years, with average cost per person-year of $257. Sensitivity analyses show our model is robust in predicting costs for the prevalent population but likely overestimates costs for the incident population. CONCLUSIONS NASH will contribute to a significant clinical and economic burden in Hong Kong over the next two decades. Due to the limited number of donors and small number of liver transplants performed annually, patients with advanced liver disease due to NASH in Hong Kong are more likely to die from NASH than their counterparts in the western hemisphere. Thus rising prevalence of metabolic syndrome in elderly adults in Hong Kong make NASH an important consideration for clinicians and policy makers.