NEW YORK, Sept. 4, 2020 /PRNewswire/ -- NASHNET, a global network of thought leaders dedicated to advancing care pathways for nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), announces the publication of a novel cost-effectiveness analysis (CEA) study in Gastroenterology, titled: Screening for Non-Alcoholic Fatty Liver Disease in Persons with Type 2 Diabetes in the U.S. is Cost Effective: A Comprehensive Cost-Utility Analysis.
Affecting over 25% of the adult population, NAFLD is the most common form of chronic liver disease in the United States, and the prevalence continues to rise (American Liver Foundation, 2020). Approximately 20% of those with NAFLD progress to NASH, the more severe manifestation of the disease, which if left undetected and unmanaged can progress to liver cirrhosis (American Liver Foundation, 2020).
Findings from the CEA study, authored by NASHNET advisors, indicated that screening ≥55-year-old patients with Type 2 Diabetes (T2D) for NAFLD was cost-effective, as compared to no screening, for all studied screening strategies, excluding those involving liver biopsy. Researchers developed a Markov model to evaluate the cost-effectiveness of six screening strategies using an incremental, threshold cost-effectiveness ratio of ≤$50,000 per quality-adjusted life year (QALY). Dr. Mazen Noureddin, Director of the Fatty Liver Program at Cedars-Sinai Medical Center (Los Angeles, CA) remarked, "as the burden of NAFLD continues to grow, it is increasingly a financial and population health issue. It is imperative that we define appropriate screening strategies for identifying patients with NAFLD to improve over all health, diagnose the disease early, reduce the associated financial burden and help inform the development of future professional guidelines." Cost-effective screening approaches observed in the study included the use of ultrasound with or without aspartate aminotransferase (AST) – or alanine aminotransferase (ALT) – to detect possible fibrosis in high-risk patient populations, then if clinically significant, the deployment of transient elastography (VCTE). Patients suspected to have NAFLD or NASH (NASH stage ≥2) were prescribed one year of intensive lifestyle intervention (ILI). Additionally, these screening strategies were found to be cost-effective for T2D patients as young as 40 years of age.
As the prevalence of NAFLD and NASH continues to rise, leveraging non-invasive tests (NITs) will become increasingly important to identify patients at greatest risk of adverse health outcomes or who might benefit from early treatment intervention. Dr. Mary Rinella, a Hepatologist from Northwestern Medicine (Chicago, IL) stated, "these data provide additional rationale to screen for NASH in a high risk population such as Diabetes. NASH is soon to be the primary indication for liver transplant, and it already is in women, so developing an economical approach for healthcare organizations to identify patients with the disease will become vital as therapeutics come to market." Recognizing a need for additional cost-effectiveness data regarding the use of NITs, this study supplements the growing evidence base demonstrating the utility of NITs for detecting and monitoring NAFLD and NASH. While liver biopsy remains the gold standard for diagnosing NASH, a number of NITs have emerged in recent years including the ultrasound, AST, ALT, VCTE, controlled attenuation parameter (CAP), and FIB-4.
References: (2020). NASH Definition & Prevalence. American Liver Foundation. Link.
NASHNET is a global Centers of Excellence Network committed to defining and spreading the best practice model for NASH care delivery. NASHNET promotes the discovery, development and optimization of care pathways and interventions that align key stakeholders, ensure appropriateness of and linkage to care, and enhance the patient experience. Learn more at https://www.nashnetwork.org/.