Disease burden and costs from excess alcohol consumption, obesity, and viral hepatitis: fourth report of the Lancet Standing Commission on Liver Disease in the UK

Roger Williams*, Graeme Alexander, Iain Armstrong, Alastair Baker, Neeraj Bhala, Ginny Camps-Walsh, Matthew E. Cramp, Simon de Lusignan, Natalie Day, Anil Dhawan, John Dillon, Colin Drummond, Jessica Dyson, Graham Foster, Ian Gilmore, Mark Hudson, Deirdre Kelly, Andrew Langford, Neil McDougall, Petra MeierKieran Moriarty, Philip Newsome, John O'Grady, Rachel Pryke, Liz Rolfe, Peter Rice, Harry Rutter, Nick Sheron, Alison Taylor, Jeremy Thompson, Douglas Thorburn, Julia Verne, John Wass, Andrew Yeoman

*Corresponding author for this work

Research output: Contribution to journalComment/debate

98 Citations (Scopus)


This report contains new and follow-up metric data relating to the eight main recommendations of the Lancet Standing Commission on Liver Disease in the UK, which aim to reduce the unacceptable harmful consequences of excess alcohol consumption, obesity, and viral hepatitis. For alcohol, we provide data on alcohol dependence, damage to families, and the documented increase in alcohol consumption since removal of the above-inflation alcohol duty escalator. Alcoholic liver disease will shortly overtake ischaemic heart disease with regard to years of working life lost. The rising prevalence of overweight and obesity, affecting more than 60% of adults in the UK, is leading to an increasing liver disease burden. Favourable responses by industry to the UK Government's soft drinks industry levy have been seen, but the government cannot continue to ignore the number of adults being affected by diabetes, hypertension, and liver disease. New direct-acting antiviral drugs for the treatment of chronic hepatitis C virus infection have reduced mortality and the number of patients requiring liver transplantation, but more screening campaigns are needed for identification of infected people in high-risk migrant communities, prisons, and addiction centres. Provision of care continues to be worst in regions with the greatest socioeconomic deprivation, and deficiencies exist in training programmes in hepatology for specialist registrars. Firm guidance is needed for primary care on the use of liver blood tests in detection of early disease and the need for specialist referral. This report also brings together all the evidence on costs to the National Health Service and wider society, in addition to the loss of tax revenue, with alcohol misuse in England and Wales costing £21 billion a year (possibly up to £52 billion) and obesity costing £27 billion a year (treasury estimates are as high as £46 billion). Voluntary restraints by the food and drinks industry have had little effect on disease burden, and concerted regulatory and fiscal action by the UK Government is essential if the scale of the medical problem, with an estimated 63 000 preventable deaths over the next 5 years, is to be addressed.

Original languageEnglish
Pages (from-to)1097-1107
Number of pages11
JournalThe Lancet
Issue number10125
Publication statusPublished - 17 Mar 2018

Bibliographical note

Funding Information:
MEC declares grant funding, personal fees, and non-financial support from Abbvie, Bristol-Myers Squibb, Gilead, Merck Sharp & Dohme, and Janssen. JDi declares grant funding and personal fees from Gilead, Abbvie, Merck Sharpe & Dohme, and Janssen. GF declares grant funding and personal fees from Abbvie, Gilead, and Merck Sharp & Dohme, and is the national clinical lead for HCV. PM declares grant funding from Research Councils UK, National Institute for Health Research (NIHR), governmental bodies, and medical charities, and personal fees from the Institute for Alcohol Studies. PR declares personal fees from Scottish Health Action on Alcohol Problems and WHO Europe. All other authors declare no competing interests.

Funding Information:
We thank all those who attended meetings of the working groups of the Commission or contributed data or other content to this report, including Colin Angus (Sheffield Alcohol Research Group, University of Sheffield), Joanne Bosanquet, Clive Henn (Public Health England), Richard Aspinall (Queen Alexandra Hospital, Portsmouth), Alastair Baker, Marianne Samyn (King's College Hospital NHS Foundation Trust), Rachel Batterham, Alastair O'Brien (University College London Hospital), Ana Correa (RCGP Research and Surveillance Centre, Department of Clinical and Experimental Medicine, University of Surrey), Richard Gardner (British Society of Gastroenterology), Katherine Brown (Institute of Alcohol Studies), Suzanne Davison (Leeds Teaching Hospital NHS Trust), James Ferguson (Queen Elizabeth Hospital, Birmingham), Filipa Ferreira (University of Surrey), Michael Glynn (Barts Health NHS Trust), Jonny Greenberg, Jan Maly (Incisive Health), Lynda Greenslade (Royal Free Hospital), Helen Jarvis (RCGP and British Liver Trust), Stephen Liversedge (Bolton Clinical Commissioning Group), Mead Mathews (St Mary's Surgery, Southampton), Alastair MacGilchrist (Edinburgh Royal Infirmary), Martin McKee (London School of Hygiene & Tropical Medicine), Darius Mirza (Queen Elizabeth Hospital and Birmingham Children's Hospital), Zulfiquar Mirza (Chelsea and Westminster Hospital NHS Foundation Trust), Stephen Ryder (Nottingham University NHS Trust), Jeremy Shearman (Royal College of Physicians), Jyotsna Vohra (Cancer Research UK), Ben Windsor-Shellard (Office for National Statistics), Ivelina Yonova (Surrey GP practice liaison officer), and Elisa Allen (NHS Blood and Transplant, Statistics and Clinical Studies). We thank Norgine for their unrestricted grant to the Foundation for Liver Research, which has enabled the Commission to work with Incisive Health in bringing the work of the Commission to the attention of Parliament and in producing the report on the Financial Costs of Liver Disease. CD is part funded by NIHR Collaborations for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust and the NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, and is in receipt of an NIHR Senior Investigator award. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Publisher Copyright:
© 2018 Elsevier Ltd

Copyright 2021 Elsevier B.V., All rights reserved.


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