Economic and Quality-of-Life Implications of Non-Alcoholic Fatty Liver Disease
- 606 Downloads
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.
KeywordsObstructive Sleep Apnea NASH Epworth Sleepiness Scale Alcoholic Liver Disease Medical Expenditure Panel Survey
Compliance with Ethical Standards
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.
Both authors shared responsibility for the development and writing of this manuscript. Dr. Zobair Younossi is the guarantor for the overall content.
- 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.CrossRefPubMedGoogle 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).CrossRefPubMedGoogle 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).PubMedCentralCrossRefPubMedGoogle 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.
- 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.
- 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.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.
- 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.Google Scholar
- 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.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.
- 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).CrossRefPubMedGoogle 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.PubMedCentralCrossRefPubMedGoogle 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).CrossRefPubMedGoogle 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).CrossRefPubMedGoogle 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.PubMedCentralCrossRefPubMedGoogle 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.
- 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.