OBJECTIVE Nonalcoholic steatohepatitis (NASH) is a progressive form of nonalcoholic fatty liver disease (NAFLD) and is strongly associated with type 2 diabetes mellitus (T2DM). Patients with both T2DM and NASH have increased risk for adverse clinical outcomes, leading to higher risk for mortality and morbidity. We built a Markov model with 1-year cycles and 20-year horizon to estimate the economic burden of NASH with T2DM in the U.S. RESEARCH DESIGN AND METHODS Cohort size was determined by population size, prevalence of T2DM, and prevalence and incidence of NASH in 2017. The model includes 10 health states-NAFL, NASH fibrosis stages F0 through F3, compensated and decompensated cirrhosis, hepatocellular carcinoma, 1 year post-liver transplant, and post-liver transplant-as well as liver-related, cardiovascular, and background mortality. Transition probabilities were calculated from meta-analyses and literature. Annual costs for NASH and T2DM were taken from literature and billing codes. RESULTS We estimated that there were 18.2 million people in the U.S. living with T2DM and NAFLD, of which 6.4 million had NASH. Twenty-year costs for NAFLD in these patients were $55.8 billion. Over the next 20 years, NASH with T2DM will account for 65,000 transplants, 1.37 million cardiovascular-related deaths, and 812,000 liver-related deaths. CONCLUSIONS This model predicts significant clinical and economic burden due to NASH with T2DM over the next 20 years. In fact, this burden may be greater since we assumed conservative inputs for our model and did not increase costs or the incidence of T2DM over time. It is highly likely that interventions reducing morbidity and mortality in NASH patients with T2DM could potentially reduce this projected clinical and economic burden.

中文翻译：

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美国2型糖尿病患者的非酒精性脂肪性肝炎的经济和临床负担

目的非酒精性脂肪性肝炎（NASH）是非酒精性脂肪肝疾病（NAFLD）的一种进展形式，与2型糖尿病（T2DM）密切相关。患有T2DM和NASH的患者发生不良临床结果的风险增加，从而导致更高的死亡和发病风险。我们建立了一个以1年周期和20年为期的马尔可夫模型，以估计美国患有T2DM的NASH的经济负担。研究设计和方法队列规模由人口规模，T2DM的患病率以及NASH在美国的患病率和发生率决定。 2017年。该模型包括10种健康状态-NAFL，NASH纤维化阶段F0至F3，代偿和代偿失调性肝硬化，肝细胞癌，肝移植后1年和肝移植后-以及与肝有关的，心血管的和背景死亡。过渡概率是根据荟萃分析和文献计算得出的。NASH和T2DM的年度成本来自文献和计费代码。结果我们估计美国有1820万人患有T2DM和NAFLD，其中640万人患有NASH。这些患者使用NAFLD的20年费用为558亿美元。在接下来的20年中，带有T2DM的NASH将占65,000例移植，137万例与心血管相关的死亡和81.2万例与肝脏相关的死亡。结论该模型预测了在未来20年内，NASH和T2DM所带来的巨大临床和经济负担。实际上，由于我们为模型假设了保守的输入，并且随着时间的推移并未增加成本或T2DM的发生率，因此此负担可能会更大。