With the rise of fatty liver disease in the U.S. and beyond, deploying non-invasive technologies to screen and diagnose NAFLD and NASH has emerged as a top priority for many health systems around the world.
The U.S. has seen the availability of a number of elastography techniques - particularly vibration controlled transient elastography (Fibroscan®) and magnetic resonance elastography (MRE) - grow in adoption in recent years. Together, these tools can work in a complementary fashion to screen and stage liver fibrosis. Fibroscan® has excellent negative predictive value for ruling out disease. MRE has excellent positive predictive value and can confirm an elevated Fibroscan® result - often in lieu of biopsy.
To get an idea of where this diagnostic pathway may be working well, we examined the geographic accessibility in the U.S. for these two technologies. To do so, we looked at the latest CMS data available (2017) for Fibroscan® (CPT code: 91200) and compared them to the cities where MRE is currently available.
The results show significant overlap in the availability of Fibroscan® and MRE.
In total, we estimate 97.8% of Fibroscan® exams had an MRE location within a one hour drive.
There are some notable areas where there is meaningful use of Fibroscan® (Des Moines, IA; Lubbock, TX; Fort Smith, AK) without the availability of MRE. However, there are also locations where MRE is available (Tucson, AZ; Omaha, NE) , though there is not yet significant use of Fibroscan®. In these areas, a rapid, low-cost MRE and PDFF ($240 via CMS) could be used instead for screening and diagnosis.