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One of the most important challenges facing Fatty Liver stakeholders involves improving early diagnosis for patients with clinically relevant or advanced fibrosis (F2/3). Today, a significant percentage of patients learn they are living with cirrhosis in the Emergency Department during a decompensating event. Four in ten of these patients in the UK do not leave the hospital. Episode 39 reviewed a model that Ian Rowe and Richard Parker developed to determine the most cost-effective strategy for F2/3 diagnosis.

In this conversation, Ian Rowe describes the factors that motivated him and Richard Parker to build a decision model focusing on early NASH diagnosis. He identifies three data points demonstrating how severely NASH stakeholders need a better early diagnosis paradigm and then describes the five diagnostic strategies his model will test. :

1. the high percentage of people whose liver disease is picked up for the first time when they present in the ED with decompensating disease or hepatic encephalopathy
2. the fact that roughly four in ten of these patients will die during treatment for this initial round of liver disease
3. the inefficiencies around diagnostic current methods, whereby practitioners flag abnormal liver enzyme tests and refer to specialists, where it may take months to get a specialist appointment.

He then describes the five early diagnostic strategies that will be tested and contrasted in this decision curve model.