By Jon Gingrich
The COVID-19 pandemic has spawned an unprecedented health care crisis that has exacerbated a number of underlying and troublesome issues across the U.S. health care system. It has also highlighted opportunities for solving these problems, and supporting innovations that advance preventive care, address critical health care needs and improve outcomes for more Americans.
One problem of epidemic proportion is the prevalence and associated costs of underdiagnosed liver disease, which is now linked to over $100 billion in annual direct costs. Nearly a decade ago, a group of innovative, inventive and experienced business leaders, scientists and technology experts recognized the impact of this disease not only on individual health, but also the performance of health systems and provider organizations to address the highly problematic challenges associated with liver disease. This dedication of resources resulted in the development of non-invasive technology as the foundation for an effective liver disease program.
Today, FibroScan serves as an example of a pain-free, non-invasive examination of the liver. This 10-minute point-of-care procedure provides liver stiffness and fat scores for the diagnosis and monitoring of chronic liver diseases, including non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), the more severe form of NAFLD.
By helping to reverse the nation’s liver disease epidemic through early detection and monitoring of NAFLD/NASH, physician practices and hospitals place great value in acquiring a non-invasive tool, such as FibroScan, to be utilized at the point-of-care to examine liver health. Such quantifiable information can improve individual health outcomes and enable physicians to lower payer costs by avoiding expensive, invasive interventions, such as painful liver biopsies.
Many physician groups are incorporating this non-invasive testing because, unlike blood tests that measure circulating markers of inflammation, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), point-of-care exams can directly and non-invasively measure physical properties of stiffness and fat liver, generating reproducible results and allowing for both diagnosis and monitoring of liver stiffness and liver fat.
Understanding and Treating Liver Disease
NAFLD is an asymptomatic condition characterized by elevated levels of fat in the liver and the most common type of liver disease in the Western world. Over 30% of the U.S. population has some degree of NAFLD, which is linked to diabetes, obesity, insulin resistance and other metabolic risk factors, and affects 75 to 100 million adults in the United States.
NASH is a potentially progressive liver disease that can lead to cirrhosis, hepatocellular carcinoma (HCC), liver cancer, liver transplantation and death. Estimates show that 357 million people will have NASH globally by 2030.
Because NAFLD and NASH are so tightly intertwined with obesity, diabetes and lifestyle, a “whole person” approach to patient engagement is required to support behavioral changes that will result in better outcomes across the co-morbid conditions affecting the individual patient.
Because lifestyle modifications and strict control of metabolic risk factors are the most effective treatment, early detection is needed. Disease progression is typically slow, and patients can be managed well by primary care physicians. NAFLD patients with advanced liver fibrosis should be referred to specialist care for further assessment. While finding and managing fibrotic NASH is an important component to addressing liver disease, patients with steatosis alone are at a greater risk of cardiovascular mortality and morbidity.
Diet and exercise interventions have been shown to be effective at reversing steatosis and modifying cardio-metabolic risk factors related to metabolic syndrome. For many patients, a 3% reduction in body weight has been associated with reversal of steatosis and a reduction of greater than 7% may resolve NASH in many patients.
A follow-up visit ensures that the patient is following the weight loss program, consulting with a dietician or nutritionist and adhering to the program. It’s also useful to share the patient’s liver exam score with them to illustrate the change in liver fat and the need for adjusting their treatment.
Value of Innovative Technology
As hospitals, health systems and practices initiate liver disease programs, they are evaluating technology that will best serve the needs of patients while supporting the financial goals of the organization. As these programs evolve, it’s important to look for a non-invasive liver exam tool that is highly mobile, can be operated by a medical assistant and interpreted by the healthcare professional.
The best exams produce numeric measurements—not images—for simplified interpretation and consistency of measurement. This enables clinicians to monitor changes in liver tissue over time. Experts anticipate that such rapid tools that provide consistent liver measurements will be performed as a routine part of patient management.
Jon Gingrich is CEO of Echosens North America.