, Volume 37, Issue 2, pp 267–278 | Cite as

Weight Reduction and Pioglitazone are Cost-Effective for the Treatment of Non-Alcoholic Fatty Liver Disease in Thailand

  • Bunchai Chongmelaxme
  • Pochamana Phisalprapa
  • Ratree Sawangjit
  • Piyameth DilokthornsakulEmail author
  • Nathorn ChaiyakunaprukEmail author
Original Research Article



This study evaluated lifetime liver-related clinical outcomes, costs of treatment, and the cost-effectiveness of treatment options for non-alcoholic fatty liver disease (NAFLD) in Thailand.


A cost-utility analysis using a lifetime Markov model was conducted among Thai patients with NAFLD, from a societal perspective. Pioglitazone, vitamin E, a weight reduction program, and usual care were investigated, with the outcomes of interest being the number of cirrhosis and hepatocellular carcinoma (HCC) cases, life expectancy, quality-adjusted life-years (QALYs), lifetime costs, and the incremental cost-effectiveness ratios (ICERs). One-way and probabilistic sensitivity analyses were performed.


When compared with usual care, a weight reduction program can prevent cirrhosis and HCC cases by 13.91% (95% credible interval [CrI] 0.97, 20.59) and 2.12% (95% CrI 0.43, 4.56), respectively; pioglitazone can prevent cirrhosis and HCC cases by 9.30% (95% CrI −2.52, 15.24) and 1.42% (95% CrI −0.18, 3.74), respectively; and vitamin E can prevent cirrhosis and HCC cases by 7.32% (95% CrI −4.64, 15.56) and 1.12% (95% CrI −0.81, 3.44), respectively. Estimated incremental life expectancy and incremental QALYs for all treatment options compared with usual care were approximately 0.06 years and 0.07 QALYs, respectively. The lifetime costs of both a weight reduction program and pioglitazone were less than usual care, while vitamin E was $3050 (95% CrI 2354, 3650). The weight reduction program dominated all other treatment options. The probability of being cost-effective in Thailand’s willingness-to-pay threshold ($4546/QALY gained) was 76% for the weight reduction program, 22% for pioglitazone, 2% for usual care, and 0% for vitamin E.


A weight reduction program can prevent cirrhosis and HCC occurrences, and dominates all other treatment options. Pioglitazone and vitamin E demonstrated a trend towards decreasing the number of cirrhosis and HCC cases.



The authors wish to thank Peter Barton from the writing clinic at Naresuan University Language Center for editing this work.

Author Contributions

BC and PP participated in the study concept and design, data acquisition, data analysis, data interpretation, manuscript drafting, and critical revision and final review of the manuscript. RS, PD and NC participated in the study concept and design, data interpretation, manuscript drafting, and critical revision and final review of the manuscript.

Compliance with ethical standards

Conflicts of interest

Bunchai Chongmelaxme, Pochamana Phisalprapa, Ratree Sawangjit, Piyameth Dilokthornsakul, and Nathorn Chaiyakunapruk declare no potential conflicts of interest with respect to the research, organization, and publication of this work.

Financial support

The authors received no specific funding for this work.

Supplementary material

40273_2018_736_MOESM1_ESM.docx (194 kb)
Supplementary material 1 (DOCX 193 kb)


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical SciencesNaresuan UniversityPhitsanulokThailand
  2. 2.Department of Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
  3. 3.Clinical Pharmacy Research Unit, Department of Clinical Pharmacy, Faculty of PharmacyMahasarakham UniversityMahasarakhamThailand
  4. 4.School of PharmacyMonash University MalaysiaSelangorMalaysia
  5. 5.School of PharmacyUniversity of WisconsinWisconsinUSA
  6. 6.Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) PlatformMonash University MalaysiaBandar SunwayMalaysia

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