PMID- 33822317
OWN - NLM
STAT- MEDLINE
DCOM- 20211021
LR  - 20220218
IS  - 1936-0541 (Electronic)
IS  - 1936-0533 (Print)
IS  - 1936-0533 (Linking)
VI  - 15
IP  - 4
DP  - 2021 Aug
TI  - Clinical and economic burden of nonalcoholic steatohepatitis in Saudi Arabia, 
      United Arab Emirates and Kuwait.
PG  - 912-921
LID - 10.1007/s12072-021-10182-x [doi]
AB  - 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.
CI  - (c) 2021. The Author(s).
FAU - Sanai, Faisal M
AU  - Sanai FM
AD  - Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, 
      Jeddah, Saudi Arabia.
FAU - Al Khathlan, Abdullah
AU  - Al Khathlan A
AD  - King Fahd Medical City, Riyadh, Saudi Arabia.
FAU - Al Fadhli, Ahmad
AU  - Al Fadhli A
AD  - Mubarak Al Kabeer Hospital, Jabriya, Kuwait.
FAU - Jazzar, Ahmad S
AU  - Jazzar AS
AD  - Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
FAU - Hashim, Al Moutaz
AU  - Hashim AM
AD  - Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
FAU - Mansour, Eid
AU  - Mansour E
AD  - Gilead Sciences, Dubai, United Arab Emirates.
FAU - Abaalkhail, Faisal
AU  - Abaalkhail F
AD  - King Fahad Specialist Hospital, Dammam, Saudi Arabia.
FAU - Hasan, Fuad
AU  - Hasan F
AD  - Mubarak Al Kabeer Hospital, Jabriya, Kuwait.
FAU - Al Mudaiheem, Hajer
AU  - Al Mudaiheem H
AD  - Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia.
FAU - Al Quraishi, Huda
AU  - Al Quraishi H
AD  - Rashid Hospital, Dubai, United Arab Emirates.
FAU - Bottomley, Juliana
AU  - Bottomley J
AD  - Gilead Sciences, Stockley Park, Uxbridge, UB11 1AF, UK.
FAU - Alswat, Khalid A
AU  - Alswat KA
AD  - Department of Medicine, Liver Disease Research Center, College of Medicine, King 
      Saud University, Riyadh, Saudi Arabia.
FAU - Al Ghamdi, Mohammed
AU  - Al Ghamdi M
AD  - King Fahad Military Medical Complex, Dhahran, Saudi Arabia.
FAU - Farghaly, Mohamed
AU  - Farghaly M
AD  - Dubai Health Authority, Dubai, United Arab Emirates.
FAU - Fathy, Motaz
AU  - Fathy M
AD  - Mubarak Al Kabeer Hospital, Jabriya, Kuwait.
FAU - Awad, Nancy
AU  - Awad N
AD  - IQVIA, Dubai, United Arab Emirates.
FAU - Mohamed, Omneya
AU  - Mohamed O
AD  - IQVIA, Dubai, United Arab Emirates.
FAU - Kozma, Sam
AU  - Kozma S
AD  - Gilead Sciences, Dubai, United Arab Emirates.
FAU - Al-Hamoudi, Waleed
AU  - Al-Hamoudi W
AD  - Department of Medicine, Liver Disease Research Center, College of Medicine, King 
      Saud University, Riyadh, Saudi Arabia.
FAU - Al-Jedai, Ahmed
AU  - Al-Jedai A
AUID- ORCID: 0000-0002-4730-9086
AD  - Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia. 
      ahaljedai@moh.gov.sa.
LA  - eng
PT  - Journal Article
DEP - 20210406
PL  - United States
TA  - Hepatol Int
JT  - Hepatology international
JID - 101304009
SB  - IM
MH  - Carcinoma, Hepatocellular/epidemiology
MH  - Cost of Illness
MH  - Humans
MH  - Kuwait/epidemiology
MH  - Liver Neoplasms/epidemiology
MH  - *Non-alcoholic Fatty Liver Disease/epidemiology
MH  - Saudi Arabia/epidemiology
MH  - United Arab Emirates/epidemiology
PMC - PMC8382637
OTO - NOTNLM
OT  - Cost
OT  - Disease burden
OT  - Healthcare expenditure
OT  - Humanistic
OT  - Middle East
OT  - Model
OT  - NASH
OT  - Outcomes
OT  - Patient numbers
OT  - Standard of care
COIS- 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.
EDAT- 2021/04/07 06:00
MHDA- 2022/02/08 06:00
PMCR- 2021/04/06
CRDT- 2021/04/06 12:42
PHST- 2020/12/09 00:00 [received]
PHST- 2021/03/17 00:00 [accepted]
PHST- 2021/04/07 06:00 [pubmed]
PHST- 2022/02/08 06:00 [medline]
PHST- 2021/04/06 12:42 [entrez]
PHST- 2021/04/06 00:00 [pmc-release]
AID - 10.1007/s12072-021-10182-x [pii]
AID - 10182 [pii]
AID - 10.1007/s12072-021-10182-x [doi]
PST - ppublish
SO  - Hepatol Int. 2021 Aug;15(4):912-921. doi: 10.1007/s12072-021-10182-x. Epub 2021 
      Apr 6.