Consultation document recommends use of Virtual Touch Quantification in adults and children with chronic hepatitis B or C who need assessment of liver fibrosis
The National Institute for Health and Care Excellence (NICE) has opened a consultation on its plans to support the VTq device for diagnosing and monitoring liver damage.
The provisional recommendations support using the device, Virtual Touch Quantification (VTq), in adults and children with chronic hepatitis B or C who need assessment of liver fibrosis.
Liver fibrosis occurs when there is a lot of scar tissue in the liver. This can result from damage to liver cells caused by infections such as chronic hepatitis B or C, inflammation and injury. Other causes of liver fibrosis, not considered in this guidance, can include heavy alcohol consumption, toxins and some rare inherited diseases.
Diagnosing and monitoring any liver damage caused by infections is important for ensuring that an affected person receives appropriate care and treatment
The standard methods of assessing whether there is damage in the liver are ultrasound scans, transient elastography, and biopsy. The draft guidance advises that VTq is as accurate as transient elastography in diagnosing and staging liver fibrosis, and may offer additional benefits in terms of allowing liver imaging as well as sampling selected areas.
Using VTq may also create greater savings for hospitals where liver biopsy is the primary method for diagnosing and monitoring liver fibrosis, the document states.
VTq is a software application from Siemens, which assesses the stiffness of the liver based on readings of a high intensity ultrasound wave which is transmitted through the organ.
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.
Siemens claims the benefits of VTq include the procedure being painless, and possibly safer than liver biopsy, as well as reduced costs.
The cost modelling suggests that using VTq could save around £434 per patient compared with liver biopsy, and around £53 per patient compared with transient elastography.
Professor Carole Longson, director of the NICE centre for health technology evaluation, said: “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.
“This draft guidance, developed by the independent Medical Technologies Advisory Committee (MTAC), proposes supporting VTq for diagnosing and monitoring liver fibrosis in adults and children with hepatitis B or C.
The evidence indicates that VTq may avoid the need for surgical biopsy – which could mean no pain for the patient, and potentially save the health service over £400 compared to performing a biopsy
“The evidence examined by MTAC indicates that VTq may avoid the need for surgical biopsy – which could mean no pain for the patient, and potentially save the health service over £400 compared to performing a biopsy. It could also be used for patients where obesity or other factors mean that the standard form of non-invasive fibrosis testing – transient elastography – isn’t suitable.
“MTAC also considered that VTq is likely to be used in an outpatient setting as part of the initial referral from primary care for people who test positive for chronic hepatitis B or C. Clinical experts advised there is also potential for VTq to be done in future in primary care settings, if performed by staff with specialist training in ultrasound imaging and its interpretation. We welcome comments on the draft guidance during this consultation.”
Click here for the full guidance paper. The consultation closes on 19 January.