One of the most important challenges facing Fatty Liver stakeholders involves improving early diagnosis for patients with clinically relevant or advanced fibrosis (F2/3). Today, a significant percentage of patients learn they are living with cirrhosis in the Emergency Department during a decompensating event. Four in ten of these patients in the UK do not leave the hospital. Episode 39 reviewed a model that Ian Rowe and Richard Parker developed to determine the most cost-effective strategy for F2/3 diagnosis.
This conversation starts with Louise Campbell agreeing with the vision that led Ian and Richard to build this model. She notes recent data she heard that 85% of all US patients with cirrhosis (and 55% in the UK) learn their diagnoses for the first time in an Emergency Department, which suggests the need to improve earlier diagnosis. She notes that some UK programs are widely cited as examples of good (or best) practice, but, more important, notes that these have been cited as examples for a long time, but also notes that other regions and hospitals have not emulated them.
She goes on to ask how the efficiency and number of patients captured in the model would increase if the target expanded to include all patients with metabolic disease. Ian notes that these patients were not included in the model and also suggests that the question reflects a larger question about the goal of this kind of screening.