{
  "abstract": "Background The existing surveillance pathways of steatotic liver disease (SLD) can be overstated on low-risk patients, imposing significant financial burden on health care systems with limited measurable clinical benefit. We conducted a retrospective analysis to determine areas of poor utilization of financial resources and proportional clinical benefit in patients with liver stiffness (LS) < 10 kPa. 1Methods Retrospective analysis of 159 SLD patients undergoing Fibroscan monitoring. We selected patients based on their baseline LS (<10 kPa versus ≥10 kPa) 1 and determined total healthcare costs based on NHS England National Cost Collection 2023/24 tariffs2: Fibroscan £150 (RD51Z), first appointment £250 (WF01A), follow-up £180 (WF01B), GLP-1 £2,000/year (NICE TA1026), bariatric surgery £7,000 (HRG FZ18-21). The clinical outcomes were BMI change, LS change, and liver related events in 5 years.Results 63 patients (39.6%) exhibited low-risk liver disease, defined as liver stiffness (LS) <10 kPa. 1 None of this cohort had any liver-related events in a 5-year follow-up. These patients contributed to 736 outpatient visits (32.4% of 2,286 total) and 214 FibroScans (40.4% of 532 total), which is equivalent to 11.7 visits per patient during the follow-up period. surveillance cost of this low risk sub group was £159, 540. Although it was highly monitored and offered lifestyle counselling, the mean reduction in BMI (-0.78 kg/m 2) was small and statistically non-significant. A clinically meaningful LS decrease (>2 kPa) occurred in only 20.3% (12/59) of patients, while just 33% achieved significant weight loss. As a result, the cost per successful outcome was £11,396. In comparison, the estimated cost of achieving superior outcomes with evidence-based therapies over a 2-year period is substantially lower: £8,105 for bariatric intervention3 and £5,727 for GLP-1 receptor agonist4 therapy per patient.Conclusions This analysis demonstrates substantial inefficiency in current SLD surveillance protocols. The redirection of the financial resources to more evidence-based treatments that would lead to long-term weight loss, including GLP-1 receptor agonists or bariatric interventions, would provide more significant weight losses over the long term.References Hegmar H, Wester A, et al. Liver stiffness predicts progression to liver-related events in patients with chronic liver disease – a cohort study of 14 414 patients. Liver International. 2024;44(7):1689–99.England NHS. National cost collection 2023/24. NHS England; 2024.Lassailly G, Caiazzo R, et al. Bariatric surgery provides long-term resolution of nonalcoholic steatohepatitis and regression of fibrosis. Gastroenterology. 2020;159(4):1290-301.e5.Jastreboff AM, Aronne LJ, et al. Tirzepatide once weekly for the treatment of obesity. new england journal of medicine. 2022;387(3):205–16.Abstract P53 Figure 1",
  "authors": [
    {
      "affiliations": [
        "University Hospitals of Liverpool, Liverpool, United Kingdom"
      ],
      "name": "Elliott Caddy"
    },
    {
      "affiliations": [
        "University Hospitals of Liverpool, Liverpool, United Kingdom"
      ],
      "name": "Telal Khair"
    },
    {
      "affiliations": [
        "University Hospitals of Liverpool, Liverpool, United Kingdom"
      ],
      "name": "Edward Britton"
    },
    {
      "affiliations": [
        "University Hospitals of Liverpool, Liverpool, United Kingdom"
      ],
      "name": "Omar Elshaarawy"
    }
  ],
  "title": "P53 Inefficient surveillance of low-risk steatotic liver disease: a call for resource reallocation",
  "uid": "e19d62db-efce-5fd0-8c9b-d96eb0df7c0f"
}