Episode 13 looks at the NICE Draft Guidance Evaluating FibroScan use in Community and Primary Care settings. This conversation focuses on the basic way that NICE approaches issues like this one and tensions between that approach and the health and wellness outcomes this kind of screening might provide.

As Roger Green mentions when starting this conversation, Surfing the NASH Tsunami usually advocates for early prevention and wellness care as key strategies for fighting the coming NASH pandemic. The issue is that NICE answers relatively specific questions using rigorous cost analyses. At this point in time, the caliber of longitudinal data necessary to make the optimal case for FibroScan simply does not exist.

After Roger describes the underlying issue, Ian Rowe focuses the conversation by discussing the approach that NICE takes to health economic analysis. Along the way, he notes that in cases like this one, the correct application of this generally valuable analysis might not lead to the best outcome in terms of the health of patients. Louise Campbell goes on to discuss three ways that this particular analysis fails to capture the situation accurately: (i) the test was viewed in a vacuum instead of in the context of the care it would trigger; (ii) the testing frequency was based solely on tests done in radiology departments, which appear to account for a small percentage of all FibroScan tests done in the UK; and (iii) it assumed uniform costing for FibroScan tests done in a radiology department, whereas Louise was able to point through personal experience to the deviations (both from the analysis and from each other) from the numbers used in the analysis. This conversation ends with Chris Estes discusses the idea that this should be a model of long-term inputs and outputs reflecting not only the cost of the test but also the costs and benefits of the downstream care that would result from testing.