Clinical and economic burden of nonalcoholic steatohepatitis in Saudi Arabia, United Arab Emirates and Kuwait - PubMed (original) (raw)

. 2021 Aug;15(4):912-921.

doi: 10.1007/s12072-021-10182-x. Epub 2021 Apr 6.

Abdullah Al Khathlan 2, Ahmad Al Fadhli 3, Ahmad S Jazzar 4, Al Moutaz Hashim 5, Eid Mansour 6, Faisal Abaalkhail 7, Fuad Hasan 3, Hajer Al Mudaiheem 8, Huda Al Quraishi 9, Juliana Bottomley 10, Khalid A Alswat 11, Mohammed Al Ghamdi 12, Mohamed Farghaly 13, Motaz Fathy 3, Nancy Awad 14, Omneya Mohamed 14, Sam Kozma 6, Waleed Al-Hamoudi 11, Ahmed Al-Jedai 15

Affiliations

Clinical and economic burden of nonalcoholic steatohepatitis in Saudi Arabia, United Arab Emirates and Kuwait

Faisal M Sanai et al. Hepatol Int. 2021 Aug.

Abstract

Background and aims: The Middle East (ME) has a high prevalence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), driven by obesity and type-2 diabetes mellitus (T2DM). Studies in Saudi Arabia (KSA) and United Arab Emirates (UAE) predict an escalating impact of NAFLD/NASH, particularly advanced fibrosis due to NASH (AF-NASH), increasing cases of cirrhosis, liver cancer and death. The scale of this burden in other ME countries is unknown with no reports of NAFLD/NASH healthcare resource utilization (HCRU) or costs. We estimated the clinical and economic burden of NAFLD/NASH in KSA, UAE and Kuwait.

Methods: Markov models populated with country-specific obesity and T2DM prevalence data estimated numbers and progression of NAFLD/NASH patients from 2018 to 2030. Model inputs, assumptions and outputs were collected from literature, national statistics, and expert consensus.

Results: Over 13 years, the KSA model estimated cases increasing as follows: patients with fibrosis F0-3 doubled to 2.5 m, compensated and decompensated cirrhosis and hepatocellular carcinoma trebled to 212,000; liver failure or transplant patients increased four-fold to 4,086 and liver-related death escalated from < 10,000 to > 200,000. Similar trends occurred in UAE and Kuwait. Discounted lifetime costs of NASH standard-care increased totaling USD40.41 bn, 1.59 bn and 6.36 bn in KSA, UAE (Emiratis only) and Kuwait, respectively. NASH-related costs in 2019 comprised, respectively, 5.83%, 5.80% and 7.66% of national healthcare spending.

Conclusions: NASH, especially AF-NASH, should be considered a higher priority in ME Public Health policy. Our analyses should inform health policy makers to mitigate the enormity of this escalating regional burden.

Keywords: Cost; Disease burden; Healthcare expenditure; Humanistic; Middle East; Model; NASH; Outcomes; Patient numbers; Standard of care.

© 2021. The Author(s).

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Conflict of interest statement

Faisal M Sanai is a speaker for and consultant of Gilead Sciences, Intercept Pharmaceuticals and Pfizer; Ahmad Al Fadhli, [Details Awaited]; Eid Mansour is an employee of Gilead Sciences and owns shares in Gilead Sciences;; Fuad Hasan is a consultant and speaker for Gilead Sciences; Juliana Bottomley is the Director of Amygdala Limited and received funding from Gilead Sciences, as a consultant at the time of the study reporting; Nancy Awad and Omneya Mohamed are employees of IQVIA, Dubai and received funding from Gilead Sciences to conduct the study, analyses and reporting; Sam Kozma is an employee at Gilead Sciences; Ahmed Al-jedai is an employee of Ministry of Health,Saudi Arabia; Abdullah Al Khathlan, Ahmad S Jazzar, Al Moutaz Hashim, Faisal Abaalkhail, Hajer Al Mudaiheem, Huda Al Quraishi, Khalid A Alswat, Mohammed Al Ghamdi, Mohamed Farghaly, Motaz Fathy and Waleed Al-Hamoudi report no conflicts of interest related to this manuscript.

Figures

Fig. 1

Fig. 1

Model structure

Fig. 2

Fig. 2

New cases annually per model health-state in KSA. NASH patients on Standard of Care (2018–2030): a fibrosis stages F0, F1, F2 and F3; b compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma; c liver failure or liver transplant and d liver-related death

Fig. 3

Fig. 3

Annual patient health-state model costs. NASH patients on Standard of Care—1st-Year and Subsequent Years: a KSA, b UAE and c Kuwait [USD (thousands)]

Fig. 4

Fig. 4

Breakdown of costs (USD). NASH patients on Standard of Care in KSA from 2018 to 2030. a Health-state; b cost category

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