Episode 13 looks at the NICE Draft Guidance Evaluating FibroScan use in Community and Primary Care settings. This conversation focuses on underlying tensions between a methodology designed to assess big-ticket spending on critical moments of disease and a population screening approach that centers on wellness care more than illness care.

This conversation starts with Roger Green noting an inherent tension between short-term health economic tests driving a decision not to compensate and longer-term healthcare priorities that rely on patients who cannot afford the test being able to take it. Ian Rowe describes this as a tension inherent in the UK system and therefore, not a “real issue.” In contrast, Jörn Schattenberg notes a significant structural issue in that, as Ian noted earlier, NICE relies on companies to provide the necessary data, but the costs of providing that data might be excessive for a small diagnostics company like Echosens, although not for a major drug company.

Jörn goes on to raise the issue of reimbursing wellness vs. illness; this is economics of illness analysis done for a process that enhances wellness. Louise Campbell suggests a parallel analysis of the cost of expensive HCC drugs like sorafenib that are highly costly but provide only 3-6 months added longevity. In the end, Roger Green asks one thing each participant would like to see vs. something they are confident they will see. Answers vary, but they suggest that the current system is not a particularly effective way to assess this kind of analysis and that, beyond that, this specific analysis might benefit from some different looks at data. In the end, Louise Campbell notes that the comment period ends on March 9 and invites as many people as possible to comment before then.