Disparities between research attention and burden in liver diseases: implications on uneven advances in pharmacological therapies in Europe and the USA.
Effective oral therapies for hepatitis B and C have recently been developed, while there are no approved pharmacological therapies for alcoholic and non-alcoholic fatty liver diseases (ALD and NAFLD). We hypothesise that fewer advances in fatty liver diseases could be related to disparities in research attention.



We developed the Attention-to-Burden Index (ABI) that compares the research activities during 2010-2014, and an estimate of disease burden of these 4 major liver diseases. The resulting ratio reflects either overattention (positive value) or inadequate attention (negative value) compared with disease burden. The mean research attention and disease burden were calculated from 5 and 6 different parameters, respectively. The efficacy rate of current pharmacological therapies was assessed from published clinical trials.



The mean research attention for hepatitis B and C was 31% and 47%, respectively, while NAFLD and ALD received 17% and 5%. The overall burden was 5% and 28% for hepatitis B and C, and 17% and 50% for NAFLD and ALD. The calculated ABI for hepatitis B and C revealed a +6.7-fold and +1.7-fold overattention, respectively. NAFLD received an appropriate attention compared with its burden, while ALD received marked inadequate attention of -9.7-fold. The efficacy rate of current pharmacological agents was 72% for hepatitis B, 89% for hepatitis C, 25% for non-alcoholic steatohepatitis and 13% for alcoholic hepatitis. Importantly, we found a positive correlation between the mean attention and the efficacy rate of current therapies in these 4 major liver diseases.



There are important disparities between research attention and disease burden among the major liver diseases. While viral hepatitis has received considerable attention, there is a marked inadequate attention to ALD. There is a critical need to increase awareness of ALD in the liver research community.
Divisions of Gastroenterology and Hepatology, Chapel Hill, North Carolina, USA.
Nambi
N
Ndugga
Biochemistry, Departments of Medicine and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Teisha G
TG
Lightbourne
Biochemistry, Departments of Medicine and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Kavon
K
Javaherian
Divisions of Gastroenterology and Hepatology, Chapel Hill, North Carolina, USA.
Joaquin
0000-0003-0012-484X
J
Cabezas
Biochemistry, Departments of Medicine and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Neha
N
Verma
Divisions of Gastroenterology and Hepatology, Chapel Hill, North Carolina, USA.
A Sidney
AS
Barritt
Divisions of Gastroenterology and Hepatology, Chapel Hill, North Carolina, USA.
Ramon
R
Bataller
D017281:Cost of Illness; D005060:Europe; D005234:Fatty Liver / Q000188:drug therapy / Q000209:etiology; D006509:Hepatitis B / Q000188:drug therapy / Q000209:etiology; D006526:Hepatitis C / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008107:Liver Diseases / Q000188:drug therapy* / Q000209:etiology*; D000071220:Pharmaceutical Research / Q000706:statistics & numerical data; D012106:Research / Q000706:statistics & numerical data*; D014481:United States
Hepatitis B virus; Hepatitis C virus; Non-alcoholic fatty liver disease; PUBLIC HEALTH; alcoholic liver disease