Amidst a shifting diagnostic pathway, the UK’s National Institute for Health and Care Excellence (NICE) reconsiders its position on vibration controlled transient elastography (VCTE) in the community. In this episode, Roger Green and Louise Campbell are joined by Dr Kathryn Jack and Professors Ian Rowe and William Alazawi to discuss the dynamic challenges of using FibroScan and other noninvasive tests (NITs) for best practice.
NICE and VCTE Use in Community Settings
Louise opens the conversation by reflecting on the second public meeting around considering access to FibroScan for primary care. She notes a shift from analyzing costs per test to a broader focus around how these tests are administered and to whom. The group agrees that FibroScan does not necessarily fit well within the traditional framework of NICE. Analytical challenges and out of system data obscure answers to critical questions such as what is the cost effectiveness of FibroScan in primary versus secondary care.
Kate highlights the value of developing an early screening pathway. She notes that when scanning patients, cirrhosis presents in those who have never been diagnosed with Fatty Liver. This is a pivotal opportunity to deliver a targeted intervention and support for the unwittingly cirrhotic population.
Ian challenges the practicality behind the idea that every patient in primary care should receive FibroScan. He instead suggests non-invasive fibrosis testing in selected patients in the community. “It’s important to bear in mind what NICE was asked and then to try and understand how we use FibroScan as part of the wider pathways.”
Roger notes the difference between how this process is approached in the US versus the UK. He asks the group whether there is a developed paradigm for how to adopt technology in places where the data is arriving in real time. Ian describes ways the NHS can manage uncertainty and evidence for emerging technologies, citing an example from the cancer space. The conversation shifts toward how the liver can be politicized to arrive at a quicker, better decision.
Midway through the episode, Will makes his debut after being locked out of the recording session due to technical difficulties. In true breakthrough fashion, he introduces spiky ideas linking socioeconomic strata with liver outcomes.
His thought: the more marginalized the patient, the more likely they are to encounter complications of liver disease. The group then proposes a range of factors contributing to inequity.
Kate steers discussion back to questions around administration of FibroScan and the challenges that oppose nurses and other healthcare professionals. Ian expands these questions and challenges in the context of delivering clear messaging. Settling on a simple, communicable metric may be more difficult and expensive for liver testing than other more recognized health indicators such as reading blood pressure.
At the bottom of the hour, Roger asks the panelists for one thing in this system worth improving. Ian calls for a clear pathway capable of efficient decision making. Louise hopes for NICE to take action on liver health to drive accessibility in primary care.
Kate extends this sentiment to address inequities across communities. Will is looking for stronger signaling to answer patients’ concerns: how bad is their Fatty Liver or fibrosis? Finally, Roger offers his US-centric response: if we can appropriately identify the liver’s place in multi-metabolic life, the field moves closer to acknowledgement as a big ticket item.