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S3-E16.2 – What a NASH Disease Model Reveals About Treating Advanced Fibrosis

This episode is Sponsored by Resoundant.
What can a NASH disease model teach us about treating patients with Advanced Fibrosis (F2/F3) in terms of the economic and medical rationales for therapy and optimal approaches?

This conversation starts with Roger Green asking how outputs from the NASH Disease Model are likely to shape treatment recommendations for Advanced Fibrosis in general, and specifically F2. Roger’s thought is that most of the economic value from treating F2 will come years from now in terms of reduced CV and other risks associated with metabolic syndromes. As a result, he questions whether the short-term return will support the costs of therapy.

Chris Estes responds that the cost of F2 therapy should be defensible in terms of hepatocellular carcinoma (HCC), since 40% of NASH-related HCC comes in a pre-cirrhotic patient. Presumably, a significant chunk of this pre-cirrhotic HCC comes from F2 patients. Jörn Schattenberg questions this assumption, believing instead that these patients are simply “misstated F3.” Jörn returns to Roger’s initial point, which is that the strong medical justification will be based on metabolic benefits, but these might be harder to support on a cost basis.

Louise Campbell asks whether the intensity of examining the value of F2 treatment will be tied to the presumably high costs of novel medicines and, paradoxically, the effort to reduce costs by limiting early drug use will lead to higher long-term costs because patients with the later-stage disease will require more expensive interventions. From here, Alina Allen leads the group into a discussion of how complex the factors shaping this decision will be in terms of disease stage, co-morbidities, and even the specific properties of the medication under review.

This conversation ends with Louise asking Chris how large an impact the pandemic has had on the ability to model reliably and which countries are likely to have the greater NASH-related challenges in the years ahead. Chris notes that risk is an interplay of three or four issues. The three clear factors are a rate of increase of NASH prevalence within the population, overall rate of population growth, and increasing affluence leading to more sedentary lifestyles and increased consumption of unhealthy foods. The fourth factor whose role is less clear is the level of alcohol consumption.

This conversation is sponsored by Resoundant Resoundant, a Mayo Clinic company, and the developers of Magnetic Resonance Elastography. MRE is widely available with over 2000 locations worldwide and can be done as a low-cost, rapid exam in just 5 minutes. Together with PDFF, this quantitative exam is called an Hepatogram – a powerful non-invasive alternative to liver biopsy in many cases. For more information, visit www.resoundant.com on the web.

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