1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: Allen.firstname.lastname@example.org.
2Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
3Center for Liver Diseases, Inova Medicine, Falls Church, Virginia, USA.
Left unaddressed, NAFLD will continue to have substantial health, economic and social implications. To address the challenge, a paradigm shift is needed in the way NAFLD is conceptualised. Concerted, collaborative action across medical specialities, industry sectors and governments will be vital to tackling this public health threat. To drive this change, in this review, we present current global healthcare and socioeconomic costs for NAFLD and highlight priority actions to take. The estimated healthcare costs of patients with NAFLD are nearly twice as high as their age-matched counterparts without the disease and are highest in advanced fibrosis and end-stage liver disease. NAFLD is accountable for the highest increase in disability-adjusted life years (DALYs) among all liver diseases globally. NAFLD and NASH-specific drug therapies are not available and there is considerable uncertainty regarding the cost, optimal length of treatment, impact on liver-related outcome and mortality. Among the currently available bariatric procedures, sleeve gastrectomy is reported to be the most cost-effective for NASH resolution. Gastric bypass remains very expensive, while data on bariatric endoscopy are limited. Lastly, we propose a global NAFLD/NASH investment framework to guide the development of achievable yet ambitious country-specific targets and strategic actions to optimise resource allocation and reduce the prevalence of NAFLD and NASH. Its focus on high-level inputs will be critical to enabling a political and financial environment that supports clinical-level implementation of NAFLD prevention, treatment and care efforts, across all settings.