Addressing Barriers in Advanced Fibrosis/NASH

Key opinion leaders suggest the valuable roles that clinicians, payers, and other stakeholders in healthcare can play in an effort to address unmet needs in the management of advanced fibrosis due to nonalcoholic steatohepatitis.


Norman Sussman, MD: We currently manage advanced fibrosis or progression to cirrhosis by managing complications. We don’t have any good techniques for undoing that, other than stopping the process and waiting for natural recovery. If we can find medications that accelerate that natural recovery—undo the fibrosis—we may see patients getting better very quickly. That would make life easier for everyone, including the patients, their families, and the medical societies.

The standard care is very frustrating because patients frequently, even once they know what they need to do, have a hard time following it. And so in the future I’d like to find ways to tap into people’s behavior and improve the way they see their condition, as well as improve their motivation for getting proper care.

I would like to see health agencies take a more active role in promoting health rather than curing health problems. I think payers are more focused on managing health problems than on preventing poor health. I would like to see more programs that deal with this proactively and educate people on how to live healthier lives, encouraging them to develop healthy habits that prevent disease rather than treat the disease on the back end.

Viviana Figueroa Diaz, MD: What we would really like to see is more awareness about this disease, from not only healthcare but also patients. This disease can be very silent. If there’s no awareness, screening doesn’t happen. So we need more awareness and more tools to aid in lifestyle modifications, and eventually pharmacotherapy is really what we need to attack this disease.

Mazen Noureddin, MD: One of the strategies to increase access to care is to increase education, especially in the primary care setting and in endocrinology. Another strategy is performing cost-effective analyses to make screening an effective tool to recognize more patients. The primary care as well as the endocrinology and gastroenterology guidelines could start recognizing that many of these patients who are so widely available out there are not diagnosed. Many of the experts in the field, as well as activists against this disease, have been trying to educate the community via talks or educational seminars, to tell people this is a real risk. We need to target patients who are asymptomatic, undiagnosed. They need to be recognized.

The payer organizations have been active in looking for the causes of this disease, learning about the disease, noninvasive strategies, and screening strategies to recognize these patients. Fortunately, many of them are now aware that these patients are a real risk for health economics, health changes, and big complications. Therefore, a huge effort has been started by multiple payers to 1) recognize these patients, 2) diagnose them with advanced fibrosis, and 3) come up with the best strategies to manage them, including through drug discovery in the pipeline.

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