The company claimed that use of Virtual Touch Quantification (VTq) had the potential to release resources within the NHS because the VTq procedure does not need to be carried out by a consultant and can be done in an outpatient setting. It also claimed that VTq could reduce the number of liver biopsies needed over several years if used to monitor fibrosis progression. The company was not able to identify any published evidence relating to these claims.
The published evidence provided data on the diagnostic accuracy of VTq compared with transient elastography and with liver biopsy, but none of the studies specifically explored the potential system impact of using VTq. Some authors (Friedrich‑Rust et al. 2013, Yamada et al. 2014 and Rizzo et al. 2011) mentioned in their conclusions that VTq can be used for non‑invasive assessment in people with obesity. Yamada et al. assessed the utility of VTq in predicting response to antiviral therapy and found that this had potential for people with genotype 1 hepatitis C: this could be useful in directing treatment with newer direct‑acting antiviral agents to people who are not likely to respond to existing antiviral therapies.
Four of the studies reported higher failure rates or a greater number of unreliable measurements when using transient elastography compared with VTq (Friedrich‑Rust et al. 2013, Liu et al. 2014, Rizzo et al. 2011, Sporea et al. 2012a). Sporea et al. reported that a significantly higher number of reliable measurements were taken using VTq compared with transient elastography (98.8% compared with 93.7%, p=0.003).
The Committee acknowledged that no evidence was available to demonstrate that using VTq reduces the length of hospital stay. However, it considered that using VTq could reduce the need for liver biopsies. This is likely to have an effect on resource use, particularly for children who may need a general anaesthetic and an overnight stay in hospital for liver biopsy.
The Committee considered that using VTq may provide system benefits by allowing assessment of liver fibrosis to be done at the same time as the initial diagnostic ultrasound test included in the current care pathway. The Committee heard expert clinical advice that patients being assessed for liver fibrosis usually have an ultrasound scan, and that adding VTq to the ultrasound may lead to a more streamlined care pathway. It also heard that the Siemens ultrasound machine needed for VTq can be used for other purposes. This was explored in the cost modelling (see section 5).
The Committee noted from the published evidence that VTq appears to have a lower failure rate than transient elastography, and this was confirmed by clinical expert advisers as being the case in clinical practice.
The Committee 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 that there is also potential for VTq to be used in primary care settings which offer ultrasound. The Committee was advised by clinical experts that VTq assessments should only be done by staff with specialist training in ultrasound imaging and its interpretation. The Committee also noted that transient elastography can be associated with a range of staff costs, which may be lower than those needed for VTq. The resource impact of these different staff needs was incorporated into the cost modelling done by both the company and the External Assessment Centre.
The Committee considered the issue of the VTq software package being usable only with a Siemens ultrasound machine. It noted that ultrasound machines from a variety of manufacturers are currently in use in the NHS but that individual hospitals are likely to have a number of machines. The Committee considered that the purchase of a compatible Siemens ultrasound machine for VTq can be considered as part of existing device renewal programmes.