S4-5.6 – From the VAULT: Patient Follow-Up Challenges in Modeling NASH Diagnostics

S4-5.6 - From the VAULT: Patient Follow-Up Challenges in Modeling NASH Diagnostics
This episode From the Vault comes from Season 3, Episode 39.4. Ian Rowe's decision curve model does an excellent job of modeling the success rate and cost effectiveness of modeling early NASH diagnosis. However, as Louise Campbell points out, simply getting the patient diagnosed does not mean therapeutic success, which has implications for the early diagnosis model and broader patient management issues.

One of the most important challenges facing Fatty Liver stakeholders involves improving early diagnosis for patients with clinically relevant or advanced fibrosis (F2/3). Today, a significant percentage of patients learn they are living with cirrhosis in the Emergency Department during a decompensating event. Four in ten of these patients in the UK do not leave the hospital. In this episode From the Vault, panelists review a model that Ian Rowe and Richard Parker developed to determine the most cost-effective strategy for F2/3 diagnosis.

As this conversation starts, Louise Campbell notes that John Dillon reported in Barcelona that slightly over half of patients identified as having Fatty Liver via iLFT never returned for their appointments. Ian Rowe points out that this will reduce the costs in the model due to missed diagnoses but questions whether this cost reduction is truly beneficial since missed patient visits translate into non-treatment. More important, he reminds us that iLFT is under constant improvement so that data collected earlier in its lifecycle might not accurately reflect its costs and benefits today.

Upon Roger Green’s invitation for other questions Louise Campbell asks whether “we” (presumably the UK NHS) should do a better job supporting positive diet and exercise activity for healthcare professionals inside the system. On a more serious note, this leads Ian and Louise to focus on the policy issues that can support patients better (particularly those in the workforce). Ian points out that alcohol is issue #1 for many of these patients. He and Louise go on to point out the importance of public policy around things like soda and sweet food advertising in shifting consumers’ focus or craving for bad foods. Roger suggests that this is a two-element issue: stopping advertising for soda and sweets will reduce disease over time but we also need to treat patients who already have developed disease. As he puts it, policy can “put your foot on the hose,” but even if we stop the in-flow of new Fatty Liver and metabolic patients, we still have “the patients in the hose” and they will need therapy.

As a final thought before wrap-up, Ian shares his belief (which Louise also holds) that VCTE might be more effective in causing changes in patient behavior than blood tests, even if they point up the exact same patient need. The difference: feedback from VCTE comes in real-time where patients get face-to-face feedback and respond, whereas bloodwork results comeback to the patient several days later and delivered impersonally.

From here, the group moves to the wrap-up question, which addresses research we should be doing and action steps/changes in behavior we should be promoting.

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