How will the welfare state cope with welfare diseases such as NASH?

Last year, it was stated in this journal that Non- Alcoholic Fatty Liver Disease (NAFLD) is becoming the biggest cause of liver disease in western countries (1). NAFLD may gain importance as Non-Alcoholic Steatohepatitis (NASH), a specific and serious form of NAFLD, is on the rise. It is estimated that in Belgium 3-4% of the population are affected by NASH, and it is projected that the prevalence will double by 2030 (2). Currently, over 90 drugs are being developed to treat NASH. NASH is associated with a 30% or more loss in quality of life of the patient and may lead to death. Current treatments for NASH are based on lifestyle interventions (i.e. diet, physical activity) (1). Unfortunately, it has been estimated that less than 10% of the patients manage to maintain these changes in order for the hepatic fibrosis to regress. Due to the global obesity epidemic and complications of NASH, economic analyses indicate growing costs for the healthcare system and society overall. For instance, liver cirrhosis is associated with a 19% absenteeism rate and a 45% presenteeism rate. A rough estimate for NASH in Belgium shows direct annual medical cost to range between 100 to 400 million euro (3).