Estimating utility values for non-alcoholic steatohepatitis health states: a discrete choice experiment

Background: This study estimated utility values for non-alcoholic steatohepatitis (NASH). Previous studies have assumed that health-related quality of life does not vary between the early stages of NASH. Materials & Methods: Discrete choice experiment (DCE) surveys estimated the value of avoiding fibrosis progression. Patients also completed the EQ-5D-5L. Marginal rates of substitution estimated utility change associated with fibrosis progression. Results: DCE surveys were completed by the UK general public (n = 520) and patients with NASH (n = 154). The utility decline between fibrosis stages F1 and F4 decompensated was between-0.521 to-0.646 (depending on method). Conclusion: Three methods were used to estimate utilities for NASH, each one showed sensitivity to advancing fibrosis, including in the early stages, which is often considered asymptomatic.Plain language summaryWhat is this article about? Nonalcoholic steatohepatitis (NASH) is a form of nonalcoholic fatty liver disease (NAFLD). In addition to excessive fat in the liver, NASH also includes liver inflammation and damage. Over time, NASH can cause permanent liver damage. As the condition worsens, it can have a more severe impact on patients' health-related quality of life. However, few studies have explored the impact of NASH on patients at different stages of the condition, particularly in the early stages. This study explored the impact of NASH on health-related quality of life at different disease stages.What were the results? Patients with NASH experience significant impacts on health-related quality of life, which becomes progressively worse as the condition worsens, even in the early stages of disease.What do the results of the study mean? The results show the importance patients with NASH and the public place on avoiding worsening NASH and the potential benefits of preventing worsening NASH. These results could also be used to estimate the cost-effectiveness of new NASH treatments.Tweetable abstract: Preventing worsening in liver fibrosis can produce net gains in health and quality of life. This new research explores methods for valuing these gains in health