Real-world Use of the FIB-4 Calculator in Primary Care Workflows to Screen for Advanced Nonalcoholic Fatty Liver Disease in a Large U.S. Health System

• Nonalcoholic fatty liver disease (NAFLD) affects approximately 30% of the U.S. population and is estimated to cost the U.S. healthcare system $103 billion annually in direct medical costs1-2

• Early identification of NAFLD and nonalcoholic steatohepatitis (NASH) is critical to prevent disease progression and costly downstream events including liver failure, hepatocellular cancer (HCC), and liver transplantation

• In 2021, the American Gastroenterological Association (AGA) published a NAFLD Clinical Care Pathway, which recommended the use of the FIB-4 score to risk stratify high-risk patient populations

• Ochsner Health serves as a real-world example of the impact of the FIB-4 calculator on a large U.S. health system population

Cost Utility Analysis for Screening for Fibrotic NASH in the Type 2 Population from European Countries

• Non-alcoholic fatty liver disease is the most common cause of liver disease and is the leading indication for liver transplantation1-3

• Left undetected and undiagnosed, NAFLD can progress to non-alcoholic steatohepatitis (NASH) and (in some cases) cirrhosis and/or hepatocellular carcinoma (HCC)4

• While some U.S. professional associations have not yet endorsed screening for NAFLD, EASL has advised screening for NAFLD in patients who are either obese or have metabolic syndrome5

• Both U.S. associations and EASL have acknowledged more cost-effective studies are needed which was done recently by our group for the US.

Deploying a Consensus Metabolic Dysfunction- Associated Steatohepatitis (MASH) Care Pathway and Educational Pilot in Three U.S. Health Systems

Metabolic dysfunction-associated liver disease (MASLD), formerly referred to as nonalcoholic fatty liver disease, impacts 30% of the global population.

1,2 Recent guideline updates regarding MASLD, including those from European Association for the Study of the Liver (EASL 2021) and American Association for the Study of Liver Diseases (AASLD 2023), recommend screening for advanced fibrosis in certain patients with increased risk for MASLD.

This educational pilot focused on the role primary care providers will play in the delivery of guidelines-based metabolic dysfunction-associated steatohepatitis care

CHALLENGES & OPPORTUNITIES TO MASH CARE PATHWAY IMPLEMENTATION IN EU COUNTRIES

EASLD-EASD-EASO guidelines recommend screening for metabolic dysfunction-associated steatotic liver disease (MASLD) in at-risk populations using a stepwise approach.1

However, challenges to real-world implementation persist. NASHNET identified a need to develop refined MASLD care pathways to address implementation challenges faced across EU care settings.

Best practices for screening, testing, diagnosing, and treating patients with hepatitis D (delta) virus based on global expert review and recent guidelines

Hepatitis D virus (HDV) represents the most severe form of human viral hepatitis, associated with rapid progression to cirrhosis and increased liver-related mortality.

Globally, an estimated 9-19 million individuals are anti-HDV positive. To ensure early detetion, current guidelines recommend screening all HBsAg-positive individuals or, at a minimum, those with defined risk factors.

Deploying a metabolic dysfunction-associated steatohepatitis consensus care pathway: findings from an educational pilot in three health systems

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly referred to as nonalcoholic fatty liver disease, impacts 30% of the global population.

This educational pilot focused on the role primary care pro- viders may play in the delivery of guidelines-based metabolic dysfunction-associated steatohepatitis (MASH) care.

Screening for Nonalcoholic Fatty Liver Disease in Persons with Type 2 Diabetes in the United States Is Cost-effective: A Comprehensive Cost-Utility Analysis

The US Preventative Services Task Force has no guidelines on the screening for nonalcoholic fatty liver disease (NAFLD), and the American Association for the

Study of Liver Diseases (AASLD) guidance does not recom- mend population screening for NAFLD.1 A reference cited by this guidance concluded that screening is not cost-effective2; however, new data have emerged since then. We hypothe- size that screening for NAFLD in patients with type 2 dia- betes (T2D), starting with ultrasound (US) and alanine aminotransferase or aspartate aminotransferase and fol- lowed by noninvasive testing for fibrosis to detect those most likely to have fibrosis stage
F2, is more cost-effective than not screening this population.

Best practices for screening, testing, diagnosing, and treating patients with hepatitis D (delta) virus based on global expert review and recent guidelines

Hepatitis D virus (HDV) represents the most severe form of human viral hepatitis, associated with rapid progression to cirrhosis and increased liver-related mortality. Globally, an estimated 9-19 million individuals are anti-HDV positive. To ensure early detetion, current guidelines recommend screening all HBsAg-positive individuals or, at a minimum, those with defined risk factors.

Cost Utility Analysis for Screening for Fibrotic NASH in the Type 2 Population from European Countries

• Non-alcoholic fatty liver disease is the most common cause of liver disease and is the leading indication for liver transplantation1-3

• • Left undetected and undiagnosed, NAFLD can progress to non-alcoholic steatohepatitis (NASH) and (in some cases) cirrhosis and/or hepatocellular carcinoma (HCC)4

• • While some U.S. professional associations have not yet endorsed screening for NAFLD, EASL has advised screening for NAFLD in patients who are either obese or have metabolic syndrome5

• • Both U.S. associations and EASL have acknowledged more cost-effective studies are needed which was done recently by our group for the US.