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This conversation starts by focusing on issues related to diagnostic testing and what we attempt to detect or prove with each test. It starts with Roger Green noting the challenge of widespread population testing for fast progressors: the easy, inexpensive test for widespread 1st-line population testing is FIB-4, but FIB-4's lack of positive predictive value makes it a poor test for assessing this question, besides which, as Alina Allen notes, FIB-4 will increase with age.

Chris Estes comments that modeling costs of a given approach must not only take into account the actual cost of an intervention (a drug, or surgery), but also the costs of testing, false positives, failed therapies and everything else that is part of patient diagnosis, treatment and monitoring. This leads into a brief detour on expected rates of adherence to pharmacotherapy for different types of medications.

The final portion of the main episode explores how costs are likely to change over time and the value of interventions like a sugar tax of soft-drink cup size restriction. This section includes some specific modeling challenges coupled with a general recognition that prevention is less expensive in the long-run than treatment but more difficult to fund and support in the short run. In the end, the group agrees on the need to keep collecting data and maintain a holistic perspective on NAFLD and NASH in the overall context of metabolic disease. As Chris points out, the economic effects on NASH of an effort to reduce Type 2 Diabetes are likely to be extremely powerful.

This conversation is sponsored by Resoundant, a Mayo Clinic company and the developers of Magnetic Resonance Elastography. MRE is widely available with over 2000 locations worldwide, and can be done as a low-cost, rapid exam in just 5 minutes. Together with PDFF, this quantitative exam is called an Hepatogram – a powerful non-invasive alternative to liver biopsy in many cases. For more information, visit www.resoundant.com on the web.