From the October 2017 issue of HealthCare Business News magazine

However, MRE has enabled clinicians and patients to overcome many of the technical issues with other noninvasive options – and in my view has helped fuel demand for the technology as a "one-stop shop" for liver assessment. MRE has a very low failure rate (< 4%), and performs equally as well in obese patients as those with BMIs < 30, which is a contraindication for a lower-tech, one-dimensional technique called transient elastography (Fibroscan, Echosens, Paris).

Most importantly, in dozens of clinical studies, MRE has demonstrated the highest sensitivity for detecting advanced fibrosis and cirrhosis (0.94 sensitivity for MRE versus 0.86 for transient elastography, according to a recent meta-analysis compiled by the American Gastroenterological Association). Correctly identifying patients at this acute stage of disease progression is critical, as a missed diagnosis can put the patient at risk for liver-related mortality or liver transplant (average total weighted costs of $1.4 million per transplant). In a sample population of 1,000 patients with a prevalence for advanced fibrosis of 30 percent, an MRE-based approach to staging liver fibrosis would reduce the false negative rate by more than half (14 percent to 6.3 percent), over relying on transient elastography alone.


An MRE model for liver fibrosis can also reduce HCV treatment costs
The development of a direct-acting antiviral (DAA) treatment for Hepatitis C virus (HCV) is one of the great medical stories of our time. However, the cost of the treatment plans have resulted in a rationing of sorts. In the U.S., patients must typically wait until they exhibit advanced fibrosis to quality for treatment. But new studies have shown that waiting for advanced fibrosis to manifest may actually be more costly, as the efficacy of expensive DAAs for HCV treatment is significantly better when initiated at earlier stages of fibrosis.

In a “treat earlier” scenario, patients have been found to require fewer weeks to achieve sustained virologic response (SVR), and the overall SVR success rate is significantly higher when initiated at a mild fibrotic stage (reducing the need to re-treat). By shortening the cycle time and improving the cure rate, a “treat earlier” strategy would not only save billions over the next 10 years, but also help meet the calls of the patient community to avoid waiting until advanced disease has set in. The missing element in this preferable clinical model, however, is the current diagnostic model. By only relying on one-dimensional transient elastography, clinicians lack the diagnostic capability to confidently diagnose at these stages.

October 2017 Magazine

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