Skip to main content
Log in

Economic and Quality-of-Life Implications of Non-Alcoholic Fatty Liver Disease

  • Leading Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Non-alcoholic fatty liver disease (NAFLD) is a very common chronic liver disease worldwide, is on the rise following the trend of increasing prevalence of obesity, is the second most common indication for liver transplantation, and is an important cause for hepatocellular carcinoma. Despite the increasing recognition of NAFLD as an important chronic liver disease, little has been published on the economic and health-related quality of life (HR-QOL) impact of NAFLD. We reviewed the current literature related to the economics and HR-QOL of NAFLD and found that increased costs and decreased HR-QOL were associated with NAFLD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Paredes AH, Torres DM, Harrison SA. Nonalcoholic fatty liver disease. Clin Liver Dis. 2012;16:397–419.

    Article  PubMed  Google Scholar 

  2. Karlas T, Wiegand J, Berg T. Gastrointestinal complications of obesity: non-alcoholic fatty liver disease (NAFLD) and its sequelae. Best Pract Res Clin Endocrinol Metab. 2013;27(2):195–208. doi:10.1016/j.beem.2013.02.002 (Epub 2013 Mar).

    Article  CAS  PubMed  Google Scholar 

  3. Chalasani N, et al. The diagnosis and managements of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroeneterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005–23.

    Article  PubMed  Google Scholar 

  4. 2014 Global cancer facts obtained from the world wide web at: http://www.cancerresearchuk.org/cancer-info/cancerstats/world/incidence/. Accessed 16 Jan 2015.

  5. Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, Ahmed A. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148(3):547–55 (Epub 2014 Nov 25).

    Article  PubMed  Google Scholar 

  6. Brunt EM, Kleiner DE, Wilson LA, Belt P, Neuschwander-Tetri BA; NASH Clinical Research Network (CRN). Nonalcoholic fatty liver disease (NAFLD) activity score and the histopathologic diagnosis in NAFLD: distinct clinicopathologic meanings. Hepatology. 2011;53(3):810–20. doi:10.1002/hep.24127 (Epub 2011 Feb 11).

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Moore JB. Non-alcoholic fatty liver disease: the hepatic consequence of obesity and the metabolic syndrome. Proc Nutr Soc. 2010;69(2):211–20. doi:10.1017/S0029665110000030 (Epub 2010 Feb 17).

    Article  CAS  PubMed  Google Scholar 

  8. Milić S, Lulić D, Štimac D. Non-alcoholic fatty liver disease and obesity: biochemical, metabolic and clinical presentations. World J Gastroenterol. 2014;20(28):9330–7. doi:10.3748/wjg.v20.i28.9330.

    PubMed Central  PubMed  Google Scholar 

  9. Kalaitzakis E. Fatigue in non-alcoholic fatty liver disease: is there a role for hypothyroidism. Gut. 2009;58(1):149–50.

    Article  CAS  PubMed  Google Scholar 

  10. Newton JL, Pairman J, Wilton K, Jones DE, Day C. Fatigue and autonomic dysfunction in non-alcoholic fatty liver disease. Clin Auton Res. 2009;19(6):319–26.

    Article  PubMed  Google Scholar 

  11. Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10:330–344. [PMID: 23507799]. doi:10.1038/nrgastro.2013.41 (assoc of extra hepatic).

  12. Lonardo A, Sookoian S, Chonchol M, Loria P, Targher G. Disease—atherosclerosis as a major player in the natural course of NAFLD. Curr Pharm Des. 2013;19:5177–5192. [PMID: 23432668]. doi:10.2174/13816128130301 (assoc of extra hepat).

  13. Vanni E, Bugianesi E, Kotronen A, De Minicis S, Yki-JärvinenH, Svegliati-Baroni G. From the metabolic syndrome to NAFLD or vice versa? Dig Liver Dis. 2010;42:320–330. [PMID: 20207596]. doi:10.1016/j.dld.2010.01.016.

  14. Stepanova M, Younossi ZM. Independent association between nonalcoholic fatty liver disease and cardiovascular disease in the US population. Clin Gastroenterol Hepatol. 2012;10(6):646–50. doi:10.1016/j.cgh.2011.12.039 (Epub 2012 Jan 13).

    Article  PubMed  Google Scholar 

  15. Svane MS. Madsbad S1. Bariatric surgery— effects on obesity and related co-morbidities. Curr Diabetes Rev. 2014;10(3):208–14.

    Article  CAS  PubMed  Google Scholar 

  16. Raghow R. Bariatric surgery-mediated weight loss and its metabolic consequences for type-2 diabetes. World J Diabetes. 2013;4(3):47–50. doi:10.4239/wjd.v4.i3.47.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Mattar SG, Velcu LM, Rabinovitz M, et al. Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg. 2005;242:610–7.

    PubMed Central  PubMed  Google Scholar 

  18. Barker KB, Palekar NA, Bowers SP, Goldberg JE, Pulcini JP, Harrison SA. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol. 2006;101:368–73.

    Article  PubMed  Google Scholar 

  19. Younossi ZM1, Stepanova M, Negro F, Hallaji S, Younossi Y, Lam B, Srishord M. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine (Baltimore). 2012;91(6):319–27. doi:10.1097/MD.0b013e3182779d49.

  20. Chehreh M, Vahedi M, Pourhoseingholi M, Ashtari S, Khedmat H, Amin M, et al. Estimation of diagnosis and treatment costs of non-alcoholic fatty liver disease: a two-year observation. Hepat Mon. 2013;13(5):e7382. doi:10.5812/hepatmon.7382.

    Google Scholar 

  21. Rogoff K. The purchasing power parity puzzle. J Econ Lit. 1996. 34 (2): 647–668. http://www.jstor.org/stable/2729217.

  22. The United States Medicare Program-obtained from the world wide web at http://www.benefits.gov/benefits/benefit-details/598. Accessed 8 Feb 2015.

  23. Martini EM, Garrett N, Lindquist T, Isham GJ. The boomers are coming: a total cost of care model of the impact of population aging on health care costs in the United States by Major Practice Category. Health Serv Res. 2007;42(1 Pt 1):201–18.

  24. Davis GL, Roberts WL. The healthcare burden imposed by liver disease in aging Baby Boomers. Curr Gastroenterol Rep. 2010;12(1):1–6. doi:10.1007/s11894-009-0087-2.

    Article  PubMed  Google Scholar 

  25. Garrett N, Martini EM. The boomers are coming: a total cost of care model of the impact of population aging on the cost of chronic conditions in the United States. Dis Manag. 2007;10(2):51–60.

    Article  PubMed  Google Scholar 

  26. Frith J, Day CP, Henderson E, Burt AD, Newton JL. Nonalcoholic fatty liver disease in older people. Gerontology. 2009;55:607–613. [PMID: 19690397]. doi:10.1159/000235677.

  27. Koehler EM, Schouten JN, Hansen BE, van Rooij FJ, Hofman A, Stricker BH, Janssen HL. Prevalence and risk factors of non-alcoholic fatty liver disease in the elderly: results from the Rotterdam study. J Hepatol. 2012;57:1305–1311 [PMID: 22871499]. doi:10.1016/j.jhep.2012.07.028.

  28. Wang Z, Xu M, Peng J, Jiang L, Hu Z, Wang H, Zhou S,Zhou R, Hultström M, Lai EY. Prevalence and associated metabolic factors of fatty liver disease in the elderly. Exp Gerontol. 2013;48:705–709. [PMID: 23721951]. doi:10.1016/j.exger.2013.05.059.

  29. Bertolotti M, Lonardo A, Mussi C, Baldelli E, Pellegrini E, Ballestri S, Romagnoli D, Loria P. Nonalcoholic fatty liver disease and aging: epidemiology to management. World J Gastroenterol. 2014;20(39):14185–204. doi:10.3748/wjg.v20.i39.14185.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Baumeister SE, Volzke H, Marschall P, John U, Schmidt CO, Flessa S, et al. Impact of fatty liver disease on health care utilization and costs in a general population: a 5-year observation. Gastroenterology. 2008;134:85–94.

    Article  PubMed  Google Scholar 

  31. Younossi ZM1, Zheng L, Stepanova M, Henry L, Venkatesan C, Mishra A. Trends in outpatient resource utilizations and outcomes for medicare beneficiaries with nonalcoholic fatty liver disease. J Clin Gastroenterol. 2015.

  32. Younossi ZM, Zheng L, Stepanova M, Venkatesan C, Mishra A. Clinical outcomes and resource utilisation in Medicare patients with chronic liver disease: a historical cohort study. BMJ Open. 2014;4(5):e004318.

  33. Whalley S, Puvanachandra P, Desai A, Kennedy H. Hepatology outpatient service provision in secondary care: a study of liver disease incidence and resource costs. Clin Med. 2007;7(2):119–24.

    Article  PubMed  Google Scholar 

  34. Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, Clegg AJ. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190, 215–357, iii–iv. doi:10.3310/hta13410.

  35. Loveman E, Frampton GK, Shepherd J, Picot J, Cooper K, Bryant J, Welch K, Clegg A. The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review. Health Technol Assess. 2011;15(2):1–182. doi:10.3310/hta15020.

    Article  CAS  Google Scholar 

  36. Barshop NJ, Sirlin CB, Schwimmer JB, Lavine JE. Review article: epidemiology, pathogenesis and potential treatments of paediatric non-alcoholic fatty liver disease. liment. Pharmacol Ther. 2008;28(1):13–24. doi:10.1111/j.1365-2036.2008.03703.x (Epub 2008 Apr 4).

    CAS  Google Scholar 

  37. Dan AA, Kallman JB, Wheeler A, Younoszai Z, Collantes R, Bondini S, Gerber L, Younossi ZM. Health-related quality of life in patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2007;26(6):815–20.

    Article  CAS  PubMed  Google Scholar 

  38. Afendy A, Kallman JB, Stepanova M, Younoszai Z, Aquino RD, Bianchi G, Marchesini G, Younossi ZM. Predictors of health-related quality of life in patients with chronic liver disease. Aliment Pharmacol Ther. 2009;30(5):469–76. doi:10.1111/j.1365-2036.2009.04061.x (Epub 2009 Jun 9).

    Article  CAS  PubMed  Google Scholar 

  39. David K, Kowdley KV, Unalp A, Kanwal F, Brunt EM, Schwimmer JB, NASH CRN Research Group. Quality of life in adults with nonalcoholic fatty liver disease: baseline data from the nonalcoholic steatohepatitis clinical research network. Hepatology. 2009;49(6):1904–12. doi:10.1002/hep.22868.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Newton JL, Jones DE, Henderson E, Kane L, Wilton K, Burt AD, Day CP. Fatigue in non-alcoholic fatty liver disease (NAFLD) is significant and associates with inactivity and excessive daytime sleepiness but not with liver disease severity or insulin resistance. Gut. 2008;57(6):807–13. doi:10.1136/gut.2007.139303 (Epub 2008 Feb 12).

    Article  CAS  PubMed  Google Scholar 

  41. Elliott C, Frith J, Day CP, Jones DE, Newton JL. Functional impairment in alcoholic liver disease and non-alcoholic fatty liver disease is significant and persists over 3 years of follow-up. Dig Dis Sci. 2013;58(8):2383–91. doi:10.1007/s10620-013-2657-2 (Epub 2013 Apr 23).

    Article  CAS  PubMed  Google Scholar 

  42. Hickman IJ, Jonsson JR, Prins JB, Ash S, Purdie DM, Clouston AD, Powell EE. Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life. Gut. 2004;53(3):413–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  43. Weinstein AA, Kallman Price J, Stepanova M, Poms LW, Fang Y, Moon J, Nader F, Younossi ZM. Depression in patients with nonalcoholic fatty liver disease and chronic viral hepatitis B and C. Psychosomatics. 2011;52(2):127–32. doi:10.1016/j.psym.2010.12.019.

  44. Surdea-Blaga T, Dumitraşcu DL. Depression and anxiety in nonalcoholic steatohepatitis: is there any association? Rom J Intern Med. 2011;49(4):273–80.

    PubMed  Google Scholar 

  45. Stewart K, Levenson J. Psychological and psychiatric aspects of treatment of obesity and nonalcoholic fatty liver disease. Clin Liver Dis. 2012;16:615–29.

    Article  PubMed  Google Scholar 

  46. Mavrogiannaki AN, Migdalis IN. Nonalcoholic fatty liver disease, diabetes mellitus and cardiovascular disease: newer data. Int J Endocrinol 2013;2013:450639. [PMID: 23653642]. doi:10.1155/2013/450639.

  47. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN, Farzadfar F, Riley LM, Ezzati M. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–567. [PMID: 21295846]. doi:10.1016/S0140-6736(10)62037-5.

  48. Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10:330–344. [PMID: 23507799]. doi:10.1038/nrgastro.2013.41.

  49. Lonardo A, Sookoian S, Chonchol M, Loria P, Targher G. Cardiovascular and systemic risk in nonalcoholic fatty liver disease—atherosclerosis as a major player in the natural course of NAFLD. Curr Pharm Des. 2013;19:5177–5192. [PMID: 23432668]. doi:10.2174/13816128130301.

  50. Vanni E, Bugianesi E, Kotronen A, De Minicis S, Yki-Järvinen H, Svegliati-Baroni G. From the metabolic syndrome to NAFLD or vice versa? Dig Liver Dis. 2010;42:320–330. [PMID: 20207596]. doi:10.1016/j.dld.2010.01.016.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Zobair M. Younossi.

Ethics declarations

This study was approved through our institutional review board and is in full compliance with all ethical standards regarding secondary data research. In addition, no external funding was received for this study; only internal funds were used. Zobair Younossi, MD is a consultant to Abbvie, Gilead, BMS, Intercept and GSK. Linda Henry PhD has any conflicts of interest to report.

Author contributions

Both authors shared responsibility for the development and writing of this manuscript. Dr. Zobair Younossi is the guarantor for the overall content.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Younossi, Z.M., Henry, L. Economic and Quality-of-Life Implications of Non-Alcoholic Fatty Liver Disease. PharmacoEconomics 33, 1245–1253 (2015). https://doi.org/10.1007/s40273-015-0316-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40273-015-0316-5

Keywords

Navigation