Unmet needs around CLD screening & diagnosis
Along the continuum of CLD, poor prognosis can be in part attributed to failures in the screening process
Failures in the screening process result in a high proportion of patients being diagnosed at advanced stages, underuse of curative therapies and delays in treatment delivery in clinical practice1
80% of chronic HCV infections remain undiagnosed worldwide,2 and even among those who undergo HCV screening, there are suboptimal rates of confirmatory HCV RNA testing and linkage to care3
~5% of the global population has significant undetected liver fibrosis or established cirrhosis 4
Cost-effectiveness of screening5 and detection of advanced fibrosis or cirrhosis are improved when non-invasive screening is introduced in routine clinical practice,6 leading to reduction in unnecessary referrals from primary to secondary care by 90%7
The lack of symptoms and the heterogeneity of etiologies make screening and diagnosis of CLD challenging
Globally, CLD is increasing and the heterogeneity and complexity of its etiologies is shifting,4,8,9 posing new challenges in the identification of patients at risk who remain asymptomatic, especially in early stages7
Globally, 1.5 billion people had CLD in 2017, most commonly due to:10
NAFLD is becoming an increasingly important cause of CLD worldwide concurrent with a rising burden of obesity and metabolic syndrome, rapidly shifting the relative contribution of viral hepatitis, NAFLD and ALD to the global burden of CLD8,11
Obesity: 2 billion adults
Diabetes: 400 million people
Based on the current estimates from 2015 to 2030, prevalence of NAFLD-related decompensated cirrhosis, HCC and deaths will increase by 168%, 137% and 178%, respectively12
The global burden of CLD is underestimated and neglected, and is often associated with significant social stigma
The lack of prospective, national registries and reliable data on the global burden of CLD contributes to the underestimation of the real problem8 and a general neglect of liver health knowledge globally13,14
The paucity of data translates into mortality rates that are likely to be conservative; therefore leading to an underestimation of the real burden of the disease15-17
In addition, liver health receives less attention than many other health areas and there is a need to improve public and political awareness and to ameliorate the associated stigma13,14
Think that liver health is stigmatised
Think that cirrhosis is only caused by alcohol
Learn more about unmet needs in CLD treatment
References
- Singal AG, et al. Clin Gastroenterol Hepatol 2022;20:9–18.
- Cooke GS, et al. Lancet Gastroenterol Hepatol 2019;4:135–184.
- Yehia BR, et al. PLoS One 2014;9:e101554.
- European Association for the Study of the Liver. J Hepatol 2018;69:182–236.
- Serra-Burriel M, et al. J Hepatol 2019;71:1141–5.
- Thiele M, et al. Gastroenterology 2018;154:1369–79.
- Ginès P, et al. Hepatology 2022;75:219–228.
- Moon AM, et al. Clin Gastroenterol Hepatol 2020;18:2650–2666.
- Moon AM, et al. Alimentary pharmacology & therapeutics 2017;45:1201–1212.
- Disease GBD. Lancet 2018;392:1789–1858.
- Sepanlou SG, et al. Lancet Gastroenterol Hepatol 2020;5:245–66.
- Estes C, et al. Hepatology 2018;67:123–133.
- Wahlin S. and Andersson J. Clin Res Hepatol Gastroenterol 2021;45:101750.
- Marcellin P. and Kutala BK. Liver Int 2018;38(Suppl 1):2-6.
- Mokdad AA, et al. BMC Med 2014;12:145.
- Tapper EB, et al. BMJ 2018;362:k2817.
- Asrani SK, et al. Gastroenterology 2013;145:375–82 e1-2.
