Modelling the economic and clinical burden of non-alcoholic steatohepatitis in East Asia: Data from Hong Kong
Modelling the economic and clinical burden of non-alcoholic steatohepatitis in East Asia: Data from Hong Kong
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DOI：
10.1111/hepr.13535
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发表时间：
2020-07-20
影响因子：
4.2
通讯作者：
Younossi, Zobair M.
中科院分区：
文献类型：
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作者：
Tampi, Radhika P.;Wong, Vincent Wai-Sun;Younossi, Zobair M.
目的非酒精性脂肪性肝炎（NASH）是非酒精性脂肪性肝病（NAFLD）的进展形式，由于城市化率的提高，久坐的生活方式和营养不良，亚洲的患病率正在上升。方法我们建立了一个20年的马尔可夫模型来估计香港NASH的负担。队列规模由2017年的人口规模、NAFLD患病率和NASH发病率确定。健康状况包括肝脂肪变性、0-3期纤维化、代偿性和失代偿性肝硬化、肝细胞癌、肝移植后以及肝脏相关、心血管和背景死亡率。转移概率是根据已发表的报告估计的，我们将香港医院管理局2017年的宪报价格转换为美元。我们每年给成本打3%的折扣。假设卫生公用事业与美国相同。非酒精性脂肪性肝炎将花费13.2亿美元，在20年内进行124次肝移植，平均每人每年花费257美元。敏感性分析表明，我们的模型在预测流行人群的成本方面是稳健的，但可能高估了事件人群的成本。结论非酒精性脂肪性肝炎将在未来20年内对香港造成重大的临床和经济负担。由于供体数量有限，每年进行的肝脏移植数量较少，香港因NASH导致的晚期肝病患者比北美和欧洲的患者更有可能死于NASH。因此，香港老年人代谢综合征患病率的上升使NASH成为临床医生和政策制定者的重要考虑因素。
Aim Non-alcoholic steatohepatitis (NASH) is the progressive form of non-alcoholic fatty liver disease (NAFLD) and prevalence is rising in Asia due to increasing 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, fibrosis stages 0-3, compensated and decompensated cirrhosis, hepatocellular carcinoma, post-liver transplant, and liver-related, cardiovascular, and background mortality. Transition probabilities were estimated from published reports 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 USA. Results Non-alcoholic steatohepatitis 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 Non-alcoholic steatohepatitis 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 undertaken annually, patients with advanced liver disease due to NASH in Hong Kong are more likely to die from NASH than their counterparts in North America and Europe. Thus, rising prevalence of metabolic syndrome in elderly adults in Hong Kong make NASH an important consideration for clinicians and policy makers.