8 July 2022

Health systems need to be ready to respond to evolving evidence to ensure they can always deliver efficient and equitable care.
 

What is NASH?

Non-alcoholic steatohepatitis (NASH) is chronic inflammation of the liver due to a build-up of fat, which can result in cell damage that affects liver function. The symptoms of NASH are often invisible or non-specific, making it difficult to diagnose. Many people may live with NASH unknowingly for several years – only receiving a diagnosis at a late stage of the disease. Obesity is the main risk factor for NASH, but others include diabetes, hypertension, insulin resistance and heart disease.

NASH can progress to cirrhosis (scarring of the liver caused by long-term damage), liver failure and liver cancer. In addition, it can worsen a person’s cardiometabolic condition, leading to a greater risk of death due to cardiovascular events.

NASH affected over 115 million people worldwide in 2019; by 2030, it is estimated that more than 357 million people will be affected due, in part, to increasing obesity rates. Finding appropriate care pathways for those living with the disease must be a priority for health systems.
 

Diagnosis of NASH currently relies on an invasive procedure

The only way to reliably diagnose NASH – and differentiate it from non-alcoholic fatty liver disease – is a liver biopsy (a procedure where a doctor takes a small piece of tissue from the liver, which is then examined under a microscope). Because it is invasive, people may feel nervous about undergoing the procedure and healthcare professionals may also hesitate to perform it. This contributes to late-stage diagnosis of the disease.

Interest is growing in finding non-invasive diagnostics that improve outcomes by allowing earlier diagnosis; several technologies are currently in the advanced stages of development. Should such a diagnostic become available, it ought to be integrated into care quickly while appropriate referral pathways are put in place to ensure patients have prompt access to care after diagnosis.
 

Approval of a new therapy would transform NASH care

There are currently no approved therapies to treat people with NASH, which creates another gap in care. Instead, disease management focuses on diet, exercise and lifestyle alterations aimed at weight loss; however, these changes can be difficult to achieve and maintain.

There has been a real push to find a pharmacotherapy that can treat people with NASH in recent years. Since January 2017, 363 NASH drug trials have taken place – a significant increase from the 82 trials conducted from 2000 to 2010.

The approval of a therapy would transform NASH care, but it would also require an overhaul of the current treatment pathway. Compounded by an increasing prevalence of the disease, this points to the need for health systems to be ready to ensure new treatments can be integrated into care pathways in a timely manner, and for all other facets of health systems to be adapted so equitable and timely diagnosis and care can be guaranteed for everyone living with NASH.

This is the second in a series of opinion posts about health system readiness – read the first instalment here.

Oriana Carswell, Project Officer at The Health Policy Partnership