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Last week, roughly 5,000 liver community stakeholders gathered in London for the 2022 International Liver Congress (#ILC2022,) the first major hepatology Congress to be held in person since the start of the pandemic (smaller, but very valuable, meetings like NASH-TAG, LiverCONNECT and Paris NASH have taken place with an in-person component, but the International Liver Congress and The Liver Meeting have not). The first three days of the program focused on a range of issues, with specific emphasis on non-invasive tests (NITs) and their role at different stages in diagnosis and treatment. This conversation touches on the impact that NAFLD has on patient quality-of-life and the importance of integrating quality-of-life issues and metrics into everything from clinical trials to treatment protocols.

This conversation starts with an observation from Jörn Schattenberg about the importance of looking more carefully at quality-of-life metrics, both in terms of patient treatment and clinical trial outcomes. MIchelle Long, making a closing comment, notes how much more collaborative researchers in the meeting are compared to years past. She then makes an announcement about a major, exciting change in her career, and then exits the conversation.

Zobair Younossi identifies "fatigue" as the patient-reported outcome from NAFLD that links most closely to quality-of-life issues He points out that fatigued Fatty Liver patients produce lower quality-of-life scores and also exhibit higher levels of mortality. He goes on to note that fatigue is also linked to unemployment and underemployment, which means that it has clear economic costs. Roger Green asks whether payers will accept economic analysis on this and, as a result, pay for therapy. Zobair suggests that this will depend on whether advocates can make this issue part of the policy, which will drive individual payers' behavior in the US and shape government policy elsewhere. In response to a question from Roger, Louise Campbell comments that the policy environment in the UK is not very different from the US despite differences in how care is actually paid for. She goes on to identify one challenge in this issue, which is that quality-of-life scores decline as soon as a patient becomes aware of their disease, which has the potential to complicate employee analyses when the employee is not yet a patient. She also agrees with Zobair's earlier statement that he would prescribe a slightly more expensive medication if it improves quality-of-life. Zobair closes this conversation by returning to discuss the importance of fatigue and describing himself as "heartened" that fatigue is now measured in most (if not all) clinical trials.