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NICE recommends device for diagnosing liver damage which could help thousands avoid biopsy

New NICE guidance recommends a device that could save thousands of people from needing an invasive procedure to diagnose and monitor liver damage.  The NICE guidance supports the NHS using the device, Virtual Touch Quantification (VTq), in people with chronic hepatitis B or C who need liver fibrosis assessment. Using this device could mean these patients can avoid having a biopsy – where a small piece of the liver is removed for examination. 

Liver fibrosis occurs when there is a lot of scar tissue in the liver, and makes the liver’s texture stiff. The scar tissue can result from damage to liver cells caused by infections such as chronic hepatitis B or C, inflammation and injury.  VTq is a software application which assesses the stiffness of the liver based on readings of a high intensity ultrasound wave which is transmitted through the liver. The wave travels at different speeds through liver tissue depending on whether the liver is flexible and healthy, or whether it is stiff due to fibrous scar tissue caused by damage. The device measures the speed of the sound waves to determine the condition of the liver tissue and allows the liver to be imaged at the same time. 

The benefits of VTq include the procedure being painless and possibly safer than liver biopsy, and reduced costs: using VTq could save around £434 per patient compared with liver biopsy and around £53 per patient compared with transient elastography[1].

Professor Carole Longson, director of the NICE centre for health technology evaluation, said: “This new NICE guidance recommending VTq for diagnosing and monitoring liver fibrosis is good news for people with chronic hepatitis B or C, and for the NHS. As well as meaning that these patients could avoid having invasive liver biopsies, the associated savings of more than £400 per person could result in significant savings in hospitals where liver biopsy is the primary method for diagnosing and monitoring liver fibrosis.
“Liver fibrosis can result from infections such as chronic hepatitis B and C – conditions which affect hundreds of thousands of people in the UK. Diagnosing and monitoring any liver damage caused by these infections is important for ensuring that an affected person receives appropriate care and treatment. The guidance, developed by the independent Medical Technologies Advisory Committee, says that VTq should be considered as an option for assessing liver fibrosis in people with chronic hepatitis B or C. Using the device may have benefits for people who need monitoring for fibrosis progression including  those for whom liver biopsy affects their quality of life. We hope that this guidance leads to wider use of VTq in the NHS to improve the care of patients with chronic hepatitis B or C.”

Welcoming the NICE guidance, Andrew Langford, Chief Executive of the British Liver Trust, said: “Liver disease is the third main cause of premature death and of the top five causes is the only one that continues to increase. It is vital that early diagnosis is increased so that each person can make the necessary lifestyle changes or receive treatments that will prevent progression and possibly reverse or cure their disease. VTq is an invaluable addition to making diagnosis and on-going monitoring as easy and patient centred as possible, so it’s good that the NICE guidance encourages its use.”

The guidance on the VTq device is available at http://www.nice.org.uk/mtg27