HTF Blog: Liver disease

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Noninvasive Tests Cost-Effectively Identify Patients at Risk for Liver Disease

Primary care physicians and specialists face the challenges of addressing the epidemic of liver disease, including nonalcoholic fatty liver disease (NAFLD)–a silent and potentially reversible condition—and its subtype nonalcoholic steatohepatitis (NASH), which can progress to advanced fibrosis and cirrhosis. They understand the growing need for cost-effective ways to detect and monitor liver disease.

Current approaches for identifying fibrotic NASH, however, are complicated, expensive and potentially wasteful. In a recent expert review conducted through the Chronic Liver Disease Foundation, Role of Noninvasive Tests in Clinical Gastroenterology Practices to Identify Patients with Nonalcoholic Steatohepatitis at High Risk of Adverse Outcomes: Expert Panel Recommendations, suggests a streamlined approach that is cost-effective.

This is important because approximately 85 million Americans have NAFLD, and 20 percent have NASH. Ten-year market projections for fatty liver disease direct costs of the disease are estimated to reach more than $1 trillion, and the disease often leads to developing other issues like diabetes, advanced fibrosis and increased risk of cardiovascular events.

Optimizing a Diagnostic Pathway

NAFLD and NASH are often accompanied by comorbidities, such as obesity, insulin resistance, and Type 2 diabetes mellitus. In recent years, the fibrosis stage of liver disease has been identified as the most important predictor of liver outcomes. For this reason, identifying patients with NAFLD and NASH with more advanced stages of fibrosis is critical for management.

Research suggests that a practical decision tree/algorithm to risk stratify NAFLD/NASH is the best approach for use in clinical practice. Risk stratifying should begin with algorithms using serum biomarkers, which offer the strongest evidence for identifying fibrosis in NAFLD.

In addition, clinicians can risk stratify patients with NAFLD using noninvasive tests (NITs), such as NAFLD Fibrosis Score (NFS), Fibrosis-4 Index (FIB-4) or liver stiffness measured by elastography. Based on data from FibroScan published literature, researchers identified Vibration Controlled Transient Elastography (VCTE) as a useful direct biomarker of liver stiffness and fat in point of care, with options for magnetic resonance elastography (MRE) and ultrasound-based 2D shear wave elastography (2D-SWE). Moreover, the authors identified combinations of direct biomarkers with circulating blood biomarkers, such as the FAST™ Score as cost effective options to identify probability of active fibrotic NASH among people suspected of having NAFLD.

Cost-Effective FibroScan

FibroScan provides a simple, validated and reliable exam that creates savings to health systems in two ways: 1) VCTE tests result in early identification of patients with fatty liver disease allows for proactive intervention and behavior change to slow disease progression; and for those identified with liver fibrosis, 2) VCTE tests can reduce the aggregate volume of some current diagnosis methods, such as liver biopsy.

Researchers who conducted scenario testing demonstrated positive net savings within two years across most scenarios and regions. They concluded that broad deployment of VCTE devices is a financially advantageous solution to address the fatty liver disease epidemic.

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