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Defining comprehensive models of care for NAFLD

Abstract

Non-alcoholic fatty liver disease (NAFLD) is now the leading cause of chronic liver disease globally. Despite the increased demand placed on health-care systems, little attention has been given to the design and implementation of efficient and effective models of care for patients with NAFLD. In many health-care settings, no formal pathways exist and, where pathways are in place, they are often not standardized according to good practices. We systematically searched the peer-reviewed literature with the aim of identifying published examples of comprehensive models of care that answered four key questions: what services are provided? Where are they provided? Who is offering them? How are they coordinated and integrated within health-care systems? We identified seven models of care and synthesized the findings into eight recommendations nested within the ‘what, where, who and how’ of care models. These recommendations, aimed at policy-makers and practitioners designing and implementing models of care, can help to address the increasing need for the provision of good practice care for patients with NAFLD.

Key points

  • Non-alcoholic fatty liver disease (NAFLD) places a substantial burden on health-care systems; however, little attention has been given to the management of patients with this disease within health-care settings.

  • We analysed published examples of models of care for NAFLD and developed a set of recommendations for health-care providers and policy-makers seeking to improve NAFLD care models and patient outcomes.

  • The eight recommendations detail what services are required by patients, where the services should be delivered, who should provide them and how services should be coordinated within health-care systems.

  • These recommendations can contribute to filling the dearth of guidance on NAFLD models of care and help address the increasing need for the provision of best practice care for patients.

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Fig. 1: The road to comprehensive models of care for NAFLD.

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Acknowledgements

The authors acknowledge the participants of the Wilton Park–EASL International Liver Foundation virtual meeting “Consensus on Care Pathways for NAFLD/NASH” (16 June 2020) who reviewed an earlier unpublished draft of these recommendations97. The virtual event was hosted by Wilton Park and included additional participants, staff and industry observers, who were not directly involved in the writing of this manuscript. The event was convened by the EASL International Liver Foundation (for which J.V.L. is vice-chair of the board) and funding was provided by Intercept; Intercept played no role in the development of the recommendations or the creation of this manuscript. The authors thank Marcela Villota Rivas (ISGlobal) for her contributions to the data search and analysis and for her input during the early drafting of the manuscript. J.V.L. acknowledges support to ISGlobal from the Spanish Ministry of Science, Innovation and Universities through the “Centro de Excelencia Severo Ochoa 2019-2023” Programme (CEX2018-000806-S), and from the Government of Catalonia through the “CERCA Programme”.

Review criteria

We searched the peer-reviewed literature in PubMed/Medline and reviewed all abstracts for relevance based on pre-defined criteria. In addition, we conducted an auxiliary search of abstracts from the last two instalments of major hepatology/liver conferences. Conference abstracts were only accepted for inclusion in the main results if they were associated with a peer-reviewed paper; see Supplementary Information for details of the search string and review criteria.

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Contributions

J.V.L. and H.E.M. researched data for the article, made a substantial contribution to discussion of content, wrote the article and reviewed/edited the manuscript before submission. All other authors made a substantial contribution to discussion of content, wrote the article and reviewed/edited the manuscript before submission.

Corresponding authors

Correspondence to Jeffrey V. Lazarus, Manuel Romero-Gómez or Jörn M. Schattenberg.

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J.V.L. reports grants, personal fees and other from AbbVie, MSD and Gilead Sciences, and personal fees from CEPHEID, GSK, Intercept, and Janssen outside the submitted work. Q.M.A. reports grants, personal fees and other from Allergan/Tobira, Genfit SA, Pfizer Ltd.; other from E3Bio, Eli Lilly & Company Ltd., Galmed, Grunenthal, Imperial Innovations, Inventiva, Janssen, MedImmune, NewGene, Raptor Pharma, NGMBio, Madrigal, Servier, EcoR1, 89Bio, Altimmune, Axcella, Blade, BNN Cardio, Celgene, Cirius, CymaBay, Genentech, HistoIndex, Indalo, IQVIA, Metacrine, North Sea Therapeutics, Poxel, Terns, Viking Therapeutics, and PathAI; personal fees and other from Gilead, BMS, and Novo Nordisk; grants and other from Intercept Pharma Europe Ltd., Novartis Pharma AG, and AstraZeneca; personal fees from Kenes; and grants from Abbvie, GSK, and Glympse Bio outside the submitted work. K.C. reports other from Allergan, AstraZeneca, BMS, Merck, Janssen, Coherus, Pfizer, and Genentech, grants from Gilead, Prosciento, Boehringer Ingelheim, Cirius Therapeutics, Novartis, Echosens, Poxel, Zydus, Novo Nordisk, and Eli Lilly, and grants and other from Inventiva outside the submitted work. H.C.-P. reports personal fees from Intercept, Genfit and Promethera Bioscience outside the submitted work. M.R. reports personal fees from Eli Lilly, Poxel S.A. Société, Boehringer-Ingelheim Pharma, Terra Firma, Sanofi US, Servier Labatories, PROSCIENTO, Inc., Novo Nordisk, Fishawack Group, Novartis Pharma GmbH, Target RWE, Gilead Sciences, Kenes Group, Bristol-Myers Squibb, Intercept Pharma, Inventiva, AstraZeneca, and Allergan GmbH outside the submitted work. E.A.T. reports personal fees from Gilead, Intercept, GMP Orphan and Pfizer outside the submitted work. V.W.-S.W. reports personal fees from 3V-BIO, AbbVie, Allergan, Boehringer Ingelheim, Bristol-Myers Squibb, Echosens, Gilead Sciences, Hanmi Pharmaceutical, Intercept, Merck, Novartis, Novo Nordisk, Perspectum Diagnostics, Pfizer, ProSciento, Sagimet Biosciences, TARGET PharmaSolutions, and Terns, and grants from Gilead Sciences outside the submitted work. M.R.-G. reports grants from INTERCEPT and GILEAD-SCIENCES, personal fees from SHIONOGI, ALFA-WASSERMAN, PROSCIENTO, KALEIDO, Novo Nordisk, MSD, BMS, Allergan, Boehringer-Ingelheim, Zydus, Intercept Pharma and Gilead Science outside the submitted work. J.M.S. reports personal fees from BMS, Boehringer Ingelheim, Echosens, Genfit, Gilead Sciences, Intercept Pharmaceuticals, Madrigal, Novartis, Pfizer, and Roche, grants from Gilead Sciences, Endra Life Sciences Inc., and Siemens Healthcare GmbH., and other from Falk Foundation MSD Sharp & Dohme GmbH outside the submitted work. All other authors declare no competing interests.

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Nature Reviews Gastroenterology & Hepatology thanks G. Aithal, E. Powell, and J.G. Fan for their contribution to the peer review of this work.

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Lazarus, J.V., Anstee, Q.M., Hagström, H. et al. Defining comprehensive models of care for NAFLD. Nat Rev Gastroenterol Hepatol 18, 717–729 (2021). https://doi.org/10.1038/s41575-021-00477-7

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