Chronic liver disease and cirrhosis are leading causes of death in the United States, and the spectrum of fatty liver disease (FLD) is among the most common liver condition. FLD is characterized by the accumulation of fat in liver cells and further distinguishes between nonalcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD), depending on whether heavy alcohol use is involved. Besides the distinction of alcohol use, both types of diseases have similar diagnostic pathways.
NAFLD can progress to a more advanced form known as nonalcoholic steatohepatitis (NASH). NASH consists of inflammation and cellular injury in addition to fat accumulation; it may progress to cirrhosis and hepatocellular carcinoma. A U.S. prevalence study estimated that 85.3 million Americans had NAFLD and 17.3 million had NASH in 2016. These conditions contribute billions of dollars to the country’s health care costs.
With the large population at risk for these adverse outcomes due to FLD, increasing payer focus, and looming U.S. guidelines, cost-effective and easily implemented liver assessment strategies are needed at the point of care.
Vibration-controlled transient elastography (VCTE), such as FibroScan® — a non-invasive, painless and quick examination, designed to quantify the stiffness of the liver via proprietary and patented technique of VCTE™ — and controlled attenuation parameter (CAP) represent a potential solution.
VCTE/CAP is a noninvasive screening procedure used to detect liver stiffness and fat, the two key identifying characteristics of FLD. The cost of using VCTE is an important consideration for executives when making investment decisions.
Researchers constructed an economic model to determine the potential return on investment (ROI) from deploying a VCTE/CAP–based care model to identify people with FLD in both Medicare and commercial payer settings.
Outcomes were evaluated across multiple dimensions and scenarios to estimate up to $2.64 per member per month net savings over five years. This analysis is the first to quantify potential cost savings at the population level as opposed to the individual level, making it more informative for business decision makers.
Researchers relied on longitudinal, concrete claims data to calculate disease transition probabilities, frequencies and costs – in contrast to existing literature that relied on data points through meta-analysis.
This economic model demonstrates that deploying VCTE/CAP devices to screen for and monitor liver stiffness and liver fat in members with diabetes can yield net savings to the payer, directly affecting bottom-line performance.
Although short-term costs increase due to implementation of the testing devices and the identification and management of additional patients with active liver disease, the incremental cost is outweighed by the downstream savings from the avoidance of, or delay of progression to, advanced liver disease.
The reductions in unnecessary referrals, biopsies and imaging further increase cost savings. The model also demonstrates that cost savings are increased when expanding access to a broader patient base.
High penetration of the VCTE/CAP device in primary care, combined with more intensive behavioral engagement through chronic care management programs, yield the highest returns in both Medicare and commercial settings.
VCTE/CAP can more accurately assess NAFLD over time than blood test scores, such as the FIB-4 and NAFLD fibrosis scores, which rely on biomarkers found in blood and cannot determine the severity of NAFLD in one-third of the population, for whom a quantitative test, such as VCTE/CAP, is required.
As health plans and clinicians continue to emphasize the management of liver health, it is important to focus on implementing tests that are accurate and precise—yet easy to use—in the management of high-prevalence diseases.