Spotlight Series on Hepatitis C

Canadian Physicians Reveal Their Choices for Assessing Liver Fibrosis

January 28, 2014

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Physician Satisfaction

The survey asked doctors whether non-invasive methods provided an "accurate assessment" of liver fibrosis. Most doctors (83%) agreed that they did while 9% disagreed and 9% neither agreed nor disagreed. Overall, doctors rated Fibroscan as the "best non-invasive method for [assessing the degree of liver fibrosis]."



Nearly 60% of survey respondents did not have a Fibroscan in their clinics. Furthermore, 61% of these doctors disclosed that they did not have "convenient access" to a Fibroscan elsewhere. All doctors who disclosed that they did not have a Fibroscan or convenient access to one stated that should their clinic acquire a Fibroscan or should they otherwise acquire convenient access to one, they would increase their use of it for non-invasive assessment of the liver.

Some doctors surveyed also underscored the need for the development of guidelines to help them use and interpret Fibroscan results.

A U.S. study has found that the cost of a liver biopsy is about $US 1,000 and rises to nearly $US 3,000 when complications occur.

In Canada, according to the researchers, "the [average] cost of a complicated liver biopsy requiring hospitalization [approaches $US 4,000]."

The cost of Fibroscan was a major concern for nearly 15% of doctors surveyed. Fibroscan was developed in France and approved in 2007 for use in that country, where the cost of Fibroscan machines and tests are paid for by the state. Fibroscans have subsequently become widely used throughout Western Europe. Not surprisingly, since that time, the use of liver biopsy as the initial means of assessing liver fibrosis has declined dramatically according to a survey of physicians in France. Fibroscan is approved for use in Canada, but so far, only in Quebec does the healthcare system subsidize its use.

The Canadian survey is useful because it shows that non-invasive means of assessing liver fibrosis are increasingly used and would be used by more doctors should access to Fibroscan become available in their province.


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  1. Sebastiani G, Ghali P, Wong P, et al. Physicians' practices for diagnosing liver fibrosis in chronic liver diseases: A nationwide, Canadian survey. Canadian Journal of Gastroenterology. 2014 Jan;28(1):23-30.
  2. Castera L, Denis J, Babany G, et al. Evolving practices of non-invasive markers of liver fibrosis in patients with chronic hepatitis C in France: time for new guidelines? Journal of Hepatology. 2007 Mar;46(3):528-9.
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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.

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