In March 2020 EASL launched the Hepahealth II project: a model to examine synergies between risk factors for liver disease and the impacts of potential interventions.

Hepahealth II is a mathematical modelling study quantifying the future epidemiological and economic burden of liver disease and the impact of public interventions to reduce liver disease in Europe.

Liver disease is a collection of conditions affecting the liver with increasing prevalence worldwide, and particularly in Europe. The recent analysis showed that there is variation across countries in prevalence of liver disease. This is largely the consequence of excess alcohol consumption, obesity, and viral hepatitis. Public health and population-level interventions can be effective in modifying behaviours, including reducing harmful alcohol consumption, controlling obesity levels and preventing Hepatic B and C levels. This in turn may lead to a reduction in the burden of liver disease.

However, the magnitude of health-related costs now and into the future, of specific interventions is not known. Public health policy modelling provides an important opportunity to quantify the future burden of liver disease as a result of changing trends in risk factors such as alcohol, obesity, and viral hepatitis. It also enables the impact of policy/population level interventions to be quantified over the short and long-term where traditional randomised controlled trials are neither feasible nor ethical.

The microsimulation method used for the study has been highlighted as the best method for risk factor and chronic disease modelling by the OECD. The value of this approach is that it enables interventions to be scaled to the entire populations that wouldn’t be practical or feasible in a traditional randomised trial. For the first time, we’ll bring together behavioural risk factor and NCD model with a hepatitis risk transition model to more accurately model the long-term trajectories of liver disease.

The final report is expected to be published at the beginning of 2022.

Read the 2018 HEPAHEALTH Project Report

EASL’s mission is supported by an unrestricted education grant from Bristol-Myers Squibb and Gilead. Bristol-Myers Squibb and Gilead have had no input into EASL content.

Preventing liver disease with policy measures to tackle alcohol consumption and obesity

Chronic liver disease (CLD) causes 1.8% of all deaths in Europe. Without policies to mitigate harmful alcohol consumption and obesity, that proportion will continue to increase. This study aims to estimate the impact of policy interventions targeting alcohol and obesity on the incidence of CLD and primary liver cancer in France, the Netherlands, and Romania.

A validated and peer-reviewed microsimulation model was employed using data from online databases and published literature. Static and dynamic trends in alcohol consumption and body mass index (BMI) respectively were projected from 2022 to 2030. We modeled the incidence of CLD and liver cancer under three policy scenarios versus an inaction scenario. The policies were 1€ minimum unit pricing (MUP) on alcohol; a combination of 0.7€ MUP and a sugar sweetened beverage (SSB) tax; and a combination of 0.7€ MUP, SSB tax, and a volumetric tax on alcohol.

All policies had an important impact ranging from a 2% to 7% reduction in annual incidence of chronic liver disease and liver cancer by 2030. The 1€ MUP policy had the largest predicted impact: In the three countries combined, that policy would result in 11,550 fewer cases of CLD and 7,921 fewer cases of liver cancer by 2030. Policy interventions combining a €0.7 MUP, an SSB tax, and a volumetric tax on alcohol would prevent nearly as many cases: 7,317 cases of CLD and 5,390 cases of liver cancer by 2030 compared with the inaction scenario.

In conclusion, we can reduce the number of Europeans who develop chronic liver disease or liver cancer by up to 7% before 2030 if we introduce a €1 MUP on alcohol, or we introduce complementary public health policies targeting alcohol consumption and obesity.

Preventing liver disease with policy measures to tackle alcohol consumption and obesity

This study has been supported by an unrestricted education grant from Bristol-Myers Squibb and Gilead. Bristol-Myers Squibb and Gilead have had no input into EASL content.

Preventing liver disease with policy measures to tackle alcohol consumption and obesity

Preventing liver disease with policy measures to tackle alcohol consumption and obesity

This study has been supported by an unrestricted education grant from Bristol-Myers Squibb and Gilead. Bristol-Myers Squibb and Gilead have had no input into EASL content.