Determination of needs for patient-centered and cost-effective HCV management

2013

Classification and selection of treatment
Consultation 1 (Baseline)
[...] To determine the degree of fibrosis, a fibrosis test is needed. In some hospitals, this investigation of the fibrosis, will be executed in the first consultation, in others during the second consultation. The analysis can be executed by conducting a liver stiffness measurement (e.g. FibroScan), which uses elastic waves to determine the liver stiffness and/or with a serum marker test (e.g. FibroTest, Fibrometer). [...]
Consultation 2
[...] If the fibrosis test was not conducted in the first consultation, it will be done during this second consultation: a liver stiffness measurement (e.g. FibroScan) will be executed to determine the liver stiffness (F0, F1, F2, F3, and F4) and/or with a serum marker test (e.g. FibroTest, Fibrometer). [...]

Finding
The fibrosis test is done differently depending on the hospital. As well the timing as type can differ: some hospitals test in the first, others in the second consultation. The tests that are conducted are the following: a liver stiffness measurement (e.g. FibroScan) and/or a serum marker test (e.g. FibroTest) and/or a liver biopsy (obligatory for G1, G4 and G5, not for G2 and G3).

Opportunities and recommendations
As a result of the analysis of the as?is situation and the changing environment of possible treatments, several opportunities can be identified. Below the opportunities are listed according to different themes.
Assessment of fibrosis
Referring to the following findings:
 -Finding 41: The fibrosis test is done differently depending on the hospital.
-Finding 42: Although, in the majority of all cases, a liver biopsy, which is expensive and not risk free, is from a medical point of view not needed, it always needs to be done to claim reimbursement (G1, G4 and G5).
Goal oriented assessment of fibrosis for all genotypes
As stated above, make a biopsy optional. This implies the need for a change in law. Furthermore, state a clear universal guideline for all Belgian hospitals that allows specialists to conduct an assessment of fibrosis according their opinion as an expert. An assessment of fibrosis will contain a combination of, or exclusively:
- Liver biopsy
- Liver stiffness measurement (e.g. FibroScan)
- Serum marker test (e.g. FibroTest or Fibrometer)
- ...
This should be possible for all genotypes and be reimbursed
Note: Patients with advanced fibrosis need another, more intensive, follow up.