Markov model estimates $1.2 billion 2023 NAFLD burden in Sri Lanka including diabetes

A 35-year Markov model estimated the economic burden of non-alcoholic fatty liver disease (NAFLD) in Sri Lanka, with the abstract reporting a projected population prevalence of 53% among people aged 35 and older by 2042. The simulation also estimated the total economic burden in 2023 at USD 668 million, or 0.8% of gross domestic product, for NAFLD alone. When diabetes comorbidity was included, the estimate was USD 1.2 billion, or 1.4% of GDP.

The analysis simulated NAFLD progression from 2007 to 2042 using one-year cycles and nine disease stages, ranging from early non-alcoholic steatohepatitis to liver transplantation. It incorporated obesity trends, age variations and diabetes comorbidity. Epidemiological inputs for prevalence and incidence came from published Sri Lankan community-based cohorts, while transition probabilities were adapted from published stage-specific matrices. Direct costs were based on local specialist consensus and private-sector hospital tariffs and were expressed in 2024 Sri Lankan rupees and US dollars.

The model estimated average annual per-patient costs in 2024 ranging from USD 82 at the early stage of non-alcoholic steatohepatitis to USD 377 at advanced stages. The study examined disease progression, healthcare costs and productivity losses, although the supplied abstract does not provide separate productivity-loss estimates. A deterministic sensitivity analysis used an alternative published transition matrix. The simulations, cost aggregation and analyses were performed in Microsoft Excel, with R used to cross-check matrix computations.

These findings are model estimates rather than direct measurements of disease prevalence or spending. The projections depend on the selected transition probabilities, epidemiological inputs, cost assumptions and the modeled effect of diabetes comorbidity. The abstract reports the model’s scope and principal results but does not describe the magnitude or direction of changes under the alternative transition matrix, and it does not present a comparison with other countries or health conditions. The authors concluded that the estimated burden supports a need for prevention and early intervention strategies, but the supplied evidence does not report outcomes from any such interventions.

Subject of Research: Modeled long-term economic burden of non-alcoholic fatty liver disease in Sri Lanka

Article Title: The economic burden of non-alcoholic fatty liver disease in Sri Lanka: a 35-year Markov model analysis

Article References: Niriella, M. A., de Silva, T., Fathima, H., Martinus, K., Wijesingha, I. P., Dassanayake, A. S., De Silva, A. P., & de Silva, H. J. (2026). The economic burden of non-alcoholic fatty liver disease in Sri Lanka: a 35-year Markov model analysis. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15677-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15677-7

Keywords: NAFLD, Sri Lanka, economic burden, Markov model, healthcare costs, productivity losses, diabetes comorbidity, disease progression, health economics, economic, burden, non-alcoholic