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Amidst a shifting diagnostic pathway, the UK’s National Institute for Health and Care Excellence (NICE) reconsiders its position on vibration controlled transient elastography (VCTE) in the community. In this conversation, Roger Green and Louise Campbell are joined by Dr Kathryn Jack and Professor Ian Rowe to discuss the dynamic challenges of using FibroScan and other noninvasive tests (NITs) for best practice.

Louise begins by reflecting on the experience of the second public meeting around considering access to FibroScan for primary care. In describing the evaluation process, she notes a shift from analyzing costs per test to a broader focus around how these tests are positioned in the wider pathway. Ian agrees that FibroScan does not fit well within the traditional framework of NICE. Analytical challenges and out of system data obscure answers to critical questions such as what is the cost effectiveness of FibroScan in primary versus secondary care. Kate highlights the value of developing an early screening pathway. She shares her experience that when scanning patients, cirrhosis presents in those who have never been diagnosed with Fatty Liver. This is a pivotal opportunity to deliver a targeted intervention and support for the unwittingly cirrhotic population. For Kate, the decision to reimburse FibroScan community use is a “no-brainer.” 

Ian challenges the practicality behind the idea that every patient in primary care should receive FibroScan. “It's important to bear in mind what NICE was asked and then to try and understand how we use FibroScan as part of the wider pathways.” He suggests community non-invasive fibrosis screening, but not necessarily FibroScan.