Episode 13 looks at the NICE Draft Guidance Evaluating FibroScan use in Community and Primary Care settings. This conversation focuses on some of the data issues surrounding this evaluation, ranging from the lack of the long-term data necessary to make the wellness case to narrower, more case-specific flaws in how costing data was developed.

The previous conversation looks at how NICE analyzes procedures and ways this approach might conflict with the economics of NAFLD screening. This conversation starts with Ian Rowe noting that NICE depends on the manufacturer to provide data for the analysis, but Echosens only presented one year data. Louise Campbell asks if advocates could put forward some of the Hepatitis C data to address the issue, but, as Ian points out, FibroScan is the index diagnostic for NAFLD; in contrast, it was used for disease staging in Hep C.

Jörn Schattenberg joins the conversation to note ways in which Germany and the UK are similar in terms of the relationship between reimbursement and use and other ways in which they are different. Eventually, Jörn points out, we will have 10-year data, but he asks how this can benefit patients today. Louise suggests that data and analyses exist in other settings that can help address these issues for NICE, particularly if we consider biopsy (and its costs) as the option. Ian Rowe asks “a couple of questions from the NICE perspective,” which make the point that this kind of screening probably is desirable but must be carefully managed because once tests are made available more widely, people will sign up quickly, backlogs will ensue and practices will be challenged and may wind up needing to add staff. Louise acknowledges all this and notes that this analysis places a higher training burden on the manufacturer than Phillips or GE face with ultrasound.