Background The prevalence of metabolic liver diseases in Western countries is estimated to have reached 20-30% and the trend is growing. In Italy the prevalence of non-alcoholic fatty liver disease (NAFLD) is about 25.4% and its evolved form, non-alcoholic steatohepatitis (NASH) is about 4.4%, with projections by 2030 of 29.5% and 6.3%, respectively. Steatosis is mainly caused by overweight and obesity, but type 2 diabetes (T2DM) has an increased risk of steatosis, with possible evolution into fibrosis, a consequent condition associated with increased morbidity and mortality. People with T2DM have a high prevalence of NAFLD; in addition, diabetic patients with NASH develop clinical complications more frequently, affecting costs. Many studies have now demonstrated the efficacy of pioglitazone, but also SGLT2 inhibitors and GLP1 agonists in preventing the development of NASH in subjects with diabetes: hepatological screening in patients with diabetes is therefore mandatory.

Methods A Markov model was conducted from the Italian Healthcare System perspective reporting results at 3,5,10 and 15 years. The model included NAFLD/NASH diabetic population, evaluating also the economic and social benefits of adequate screening and early treatment interventions.

Results The impact of the disease, in terms of direct health costs for the Italian Healthcare System is estimated at € 1.4 billion over 3 years, at € 3.1 and € 9.4 billion respectively at 5 and 10 years, reaching about € 17.3 billion after 15 years. In the 15 years considered (simulating the early use of antidiabetic drugs that can slow metabolic liver disease) cirrhosis, hepatocarcinomas and liver transplant would be significantly reduced. In addition, a significant reduction in mortality during the period considered would be expected.

Conclusion Patients with NASH and T2DM reported an important burden in Italy. The use of antidiabetic drugs that have been shown to be effective in achieving glycemic targets, but also in preventing hepatological complications, represents an opportunity to obtain clinical and economic benefits.

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Key words: Diabetes, NAFLD, Fibrosis, NASH, Shear wave