This conversation is part of SurfingNASH’s 2021 NAFLD Year-In-Review. Professor Jörn Schattenberg of the University of Mainz joins Louise Campbell and Roger Green to discuss research and insights regarding NASH cost effectiveness studies and related issues of quality of life.
Jörn Schattenberg begins our discussion simply by reviewing some of the year’s highlights. His “proof of momentum” statement is unique and dead-on at the same time: Fatty Liver topics were addressed in three New ENgland Journal of Medicine articles this year despite not having a new drug approval. When discussing the Liver International paper on which Jörn was first author (and Vlad Ratziu was the last author), he noted two key non-economic issues. First, countries tabulated and manage patient populations differently. Second, Jörn notes that most countries underdiagnose NASH and NAFLD and spend most of the money with end-stage disease. Roger and Louise both suggest that we might be able to save much of the late-stage money with better early diagnosis or, as Louise puts it, “early opportunity to stop something.” Jörn expands on the point by noting that Fatty Liver is a mirror on the entire metabolic system, so early diagnosis of Fatty Liver has benefits far beyond impact on the liver end point. Louise continues to drive a spirited discussion about the importance of early diagnosis, at one point noting that her car gets a complete check-over but our bodies don’t. As the conversation continues to cover a broad landscape, Jörn notes the well-documented links between fibrosis stage and quality of life and that the economic benefits of high quality of life are well known. Roger raises Alina Allen’s suggestion of using AI to analyze Electronic Health Records, after which Jörn expresses his appreciation for the efficiency and data richness of this idea. The group continues to review different metrics (age, which is more common, dental care, which are less so). The conversation continues to move quickly, shifting from global screening to German medical studies teaching health and diet in public schools to the non-productive (perhaps even counter-productive?) budgeting practices of the NHS. In the end, the group comes back to Louise’s fascinating vision of the body as an integrated system.