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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. This final conversation centers around how to create and train on delivering meaningful test results to patients. 

Roger Green begins with his note that in recent NASH Tsunami episodes, panelists have stated that their countries could not automate FIB-4 simply because liver enzyme tests are not standard in blood panels. This prompts Will Alazawi to suggest that a campaign similar to the one for people with diabetes on learning their HbA1c levels might go a long way toward driving between enzyme collection and FIB-4 use. Ian Rowe asks which number would be used for the liver. Louise answers that FibroScan results provide multiple metrics worth considering. She adds that while FibroScan offers substantial value, acquisition is too expensive to provide at scale. However, the less expensive tests are not adequately standardized or validated as predictive at an individual level. 

The rest of the conversation centers on ways to consider and use tests before finishing with the closing question. Roger asks the panelists for one thing in this system worth improving. Ian calls for a clear pathway capable of efficient decision making. Louise hopes for NICE to take action on liver health to drive accessibility in primary care. Kate extends this sentiment to address inequities across communities. Will is looking for stronger signaling to answer patients' concerns: how bad is their Fatty Liver or fibrosis? Finally, Roger offers his US-centric response: if we can appropriately identify the liver’s place in multi-metabolic life, the field moves closer to acknowledgement as a big ticket item.