Article Abstract

Economic burden and healthcare utilization in nonalcoholic fatty liver disease

Authors: Eric R. Yoo, Aijaz Ahmed, Donghee Kim


In the United States (US), the shift in the treatment paradigm following the introduction of second generation direct-acting antiviral (DAA) agents for hepatitis C virus (HCV) infection has favorably transformed the landscape of end-stage liver disease (ESLD) with a rapid decline in HCV-related liver transplantation; HCV had been the leading indication for liver transplantation for the last two decades (1). While the rate of liver transplantation in patients with HCV infection has plummeted in the US following the widespread application of DAA-based regimens in the pre-transplant setting, the rise in alcohol use disorder and obesity has catapulted alcoholic liver disease (ALD) to become the leading indication for liver transplantation in the US in 2016 followed closely by nonalcoholic steatohepatitis (NASH), a progressive subset of nonalcoholic liver disease (NAFLD) (1). Despite the decline in HCV-related liver transplantation in the US, the total number of liver transplants per year are on an upward trajectory as a result of marked increase in ESLD associated with ALD and NASH—an ominous trend.