Study Evaluates the Cost-Effectiveness of NASH and NAFLD Screening

by Lauren Taylor from In The Cloud Copy

Nonalcoholic fatty liver disease, or NAFLD, and nonalcoholic steatohepatitis, or NASH, are two conditions affecting the liver that plague millions of Americans every year. NAFLD is a condition that occurs when excess fat is stored in the patient’s liver. This condition is often confused with alcoholic liver disease, which causes a build-up of fat in the liver but is due to heavy alcohol use. There are two types of NAFLD, non-alcoholic fatty liver and NASH. In non-alcoholic fatty liver, there is fat in the liver but there is minimal or no inflammation on the liver or evidence of liver cell damage. Non-alcoholic fatty liver does not typically progress to a degree that causes damage or further complications.

NASH is a type of NAFLD in which the affected individual has hepatitis, which is inflammation of the liver, as well as evidence of liver cell damage and fat in the liver. The inflammation and cell damage can lead to fibrosis or scarring of the liver. NASH may eventually lead to cirrhosis or liver cancer.

These conditions are very commonly seen in people with certain conditions such as obesity and diabetes and are more commonly seen in people of Latin or Hispanic origin.

NASHNET Looking to Change Screening Criteria

NASHNET is a network of researchers and clinicians focused on bettering the care for patients with NAFLD and NASH. According to NASHNET, greater than 25% of the adult population is affected by NAFLD and this number is rising. NASHNET conducted the CEA study, which found that for patients greater than or equal to 55 years of age with a diagnosis of type 2 diabetes (T2D), screening for NAFLD was more cost-effective than no screening at all. This included all screening strategies, except liver biopsies.

Clinicians support the need for earlier testing as a cost-effective strategy as they note the increasing financial and population health burden that NAFLD is causing. This study used the cost-effective approach of ultrasound for screening, some with aspartate aminotransferase (AST) or alanine aminotransferase (ALT), some without. The ultrasound’s purpose was to identify fibrosis in patients that are considered high-risk. If clinically appropriate, after the ultrasound, clinicians would use transient elastography (VCTE), which can quantify liver fibrosis. After these non-invasive tests, patients identified as having NAFLD or NASH were advised on an intensive lifestyle intervention that would span one year. NASHNET also found these screening techniques to be effective from a monetary standpoint in patients as young as 40 who had T2D.

With rising rates of both NAFLD and NASH, providers continue to push for non-invasive testing techniques to help in identification of patients who are highest risk and whose health would benefit most from early interventions. The data from this study helps clinicians provide rationale for early screening for NAFLD and NASH in populations that are considered high risk. With liver transplantation being the ultimate treatment for NASH, being able to identify and control the disease early before getting to the point of needing a transplant will save millions of dollars and improve outcomes for patients. While liver biopsy will remain the standard for diagnosis of NASH, the non-invasive tests that have been introduced are a great supplement for screening patients early.

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