Title: Economic Burden of Non-Alcoholic Steatohepatitis with Significant Fibrosis in Thailand
Version: 1 Date: 21 Jan 2021
Reviewer's report:
Overall this is a well-researched and conducted modeling analysis of the economic burden of
NAFLD and NASH in the Thai population. However, I was confused about how some of the
inputs and data are presented, and would request clarification from the authors.
1. Overall, I am confused about what is reported in the text and the model figure. What is the
population being modeled – the prevalent NAFLD population or the total Thai population?
a. What is the purpose of the ‘normal state’ and what does it represent with respect to NAFLD
– is it the benign NAFL state or is it just the general Thai population without NAFLD?
b. Should the entire cohort enter the model at the normal state? To be more realistic, it would
make more sense for proportions of the population to enter the model with an appropriate
distribution across the health states – for example, 80% in low fibrosis states and 20% with
advanced fibrosis/ cirrhosis - and then varied in the sensitivity analysis.
2. Can you clarify what constitutes incidence of NAFLD – moving from normal to F0? And then
incidence of NASH with significant fibrosis is transition from F1 to F2?
3. Results section: Should the lifetime cost be compared to the 2019 GDP (or is it the $5147
per case value).
4. Are there only two transition probabilities that vary by age: ASMR and Normal to F0 (I assume
this is incidence of NAFLD, but am not sure – se #1 above) the only transition probability It
would be reasonable to assume the probability of receiving a liver transplant also decreases with
age.
5. Costs – as cost data for compensated and decompensated cirrhosis and HCC were derived
from Hep C data, please clarify in the text that cost of anti-viral medication was excluded from
the study. Are costs for viral testing (as part of NAFLD diagnosis) included? Please include that
costs are reported in 2019 US Dollars to Tables 1, 3, 4.
6. Line 166: From the supplementary data, it seems that NAFLD and NASH prevalence were
calculated from other studies, so line 166 in the Results should be changed to reflect this (the
model is not estimating these values as they are inputs).
Title: Economic Burden of Non-Alcoholic Steatohepatitis with Significant Fibrosis in Thailand
Version: 1 Date: 21 Jan 2021
Reviewer's report:
Overall this is a well-researched and conducted modeling analysis of the economic burden of
NAFLD and NASH in the Thai population. However, I was confused about how some of the
inputs and data are presented, and would request clarification from the authors.
1. Overall, I am confused about what is reported in the text and the model figure. What is the
population being modeled – the prevalent NAFLD population or the total Thai population?
a. What is the purpose of the ‘normal state’ and what does it represent with respect to NAFLD
– is it the benign NAFL state or is it just the general Thai population without NAFLD?
b. Should the entire cohort enter the model at the normal state? To be more realistic, it would
make more sense for proportions of the population to enter the model with an appropriate
distribution across the health states – for example, 80% in low fibrosis states and 20% with
advanced fibrosis/ cirrhosis - and then varied in the sensitivity analysis.
2. Can you clarify what constitutes incidence of NAFLD – moving from normal to F0? And then
incidence of NASH with significant fibrosis is transition from F1 to F2?
3. Results section: Should the lifetime cost be compared to the 2019 GDP (or is it the $5147
per case value).
4. Are there only two transition probabilities that vary by age: ASMR and Normal to F0 (I assume
this is incidence of NAFLD, but am not sure – se #1 above) the only transition probability It
would be reasonable to assume the probability of receiving a liver transplant also decreases with
age.
5. Costs – as cost data for compensated and decompensated cirrhosis and HCC were derived
from Hep C data, please clarify in the text that cost of anti-viral medication was excluded from
the study. Are costs for viral testing (as part of NAFLD diagnosis) included? Please include that
costs are reported in 2019 US Dollars to Tables 1, 3, 4.
6. Line 166: From the supplementary data, it seems that NAFLD and NASH prevalence were
calculated from other studies, so line 166 in the Results should be changed to reflect this (the
model is not estimating these values as they are inputs).
Please review this paper.
user
Title: Economic Burden of Non-Alcoholic Steatohepatitis with Significant Fibrosis in Thailand
Version: 1 Date: 21 Jan 2021
Reviewer's report:
Overall this is a well-researched and conducted modeling analysis of the economic burden of
NAFLD and NASH in the Thai population. However, I was confused about how some of the
inputs and data are presented, and would request clarification from the authors.
1. Overall, I am confused about what is reported in the text and the model figure. What is the
population being modeled – the prevalent NAFLD population or the total Thai population?
a. What is the purpose of the ‘normal state’ and what does it represent with respect to NAFLD
– is it the benign NAFL state or is it just the general Thai population without NAFLD?
b. Should the entire cohort enter the model at the normal state? To be more realistic, it would
make more sense for proportions of the population to enter the model with an appropriate
distribution across the health states – for example, 80% in low fibrosis states and 20% with
advanced fibrosis/ cirrhosis - and then varied in the sensitivity analysis.
2. Can you clarify what constitutes incidence of NAFLD – moving from normal to F0? And then
incidence of NASH with significant fibrosis is transition from F1 to F2?
3. Results section: Should the lifetime cost be compared to the 2019 GDP (or is it the $5147
per case value).
4. Are there only two transition probabilities that vary by age: ASMR and Normal to F0 (I assume
this is incidence of NAFLD, but am not sure – se #1 above) the only transition probability It
would be reasonable to assume the probability of receiving a liver transplant also decreases with
age.
5. Costs – as cost data for compensated and decompensated cirrhosis and HCC were derived
from Hep C data, please clarify in the text that cost of anti-viral medication was excluded from
the study. Are costs for viral testing (as part of NAFLD diagnosis) included? Please include that
costs are reported in 2019 US Dollars to Tables 1, 3, 4.
6. Line 166: From the supplementary data, it seems that NAFLD and NASH prevalence were
calculated from other studies, so line 166 in the Results should be changed to reflect this (the
model is not estimating these values as they are inputs).
assistant