1 Recommendations

Guidance

This guidance does not evaluate use of FibroScan for wider use than what is currently recommended in national guidelines. For example, it does not evaluate use of FibroScan outside secondary and specialist care to allow widespread screening for early liver disease. The recommendation for its use outside secondary and specialist care does not affect who should have testing as recommended in national guidelines.

1.1 FibroScan is recommended as an option for assessing liver fibrosis or cirrhosis outside secondary and specialist care if:

each FibroScan device is expected to be used for at least 500 scans per year, typically requiring use in locations which cover larger populations, such as community diagnostic hubs
this is likely to improve access to testing for underserved groups
it is used in accordance with national guidelines (see sections 2.3 to 2.5)
a clear care pathway with guidance for healthcare professionals doing the test on what to do based on a FibroScan result is established locally through collaboration between primary or community care and secondary or specialist care providers
there is training for healthcare professionals on how to do the test, and
the company provides supporting materials to make sure people using the test continue to use it correctly.

Why the committee made these recommendations

Using FibroScan to assess liver fibrosis and cirrhosis outside secondary and specialist care has the potential to detect liver disease earlier. Providing tests at locations that are closer to more people who need them may improve access and attendance at appointments. This may also reduce health inequalities for people from underserved groups (such as disabled people, people living in rural areas or people from lower socioeconomic backgrounds).

This assessment did not assess wider use of FibroScan than what is currently recommended in national guidelines (see sections 2.3 to 2.5). It only considered changing the location of testing and therefore FibroScan is only recommended for use outside secondary and specialist care in line with national guidelines. To maintain test performance, testing should be done as part of a clear care pathway. Also, training on doing the test should be provided and trained operators should use the device frequently to maintain their expertise.

There is some uncertainty about the overall long-term costs of using the test outside secondary and specialist care. But, it is likely that if each device is used frequently, the immediate costs of doing a test in the community will be lower than the cost of referring a person for testing in secondary or specialist care. So, FibroScan is recommended as an option for assessing liver fibrosis and cirrhosis outside secondary and specialist care.