PWE-075 Managing nafld via a multidisciplinary clinic approach improves liver health and is cost effective

Introduction Non-Alcoholic Fatty Liver Disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is tightly associated with type 2 diabetes (T2DM). Management centres around weight loss and therapies for diabetes and cardiovascular disease to reduce metabolic risk. A multidisciplinary approach involving hepatologists and diabetologists alongside allied health professionals providing structured lifestyle advice is advocated. Objective evaluations of this approach are limited. Methods We undertook a retrospective study to determine the impact of a large, tertiary centre, multidisciplinary metabolic hepatology clinic. Detailed health parameters and surrogate markers for liver and cardio-metabolic disease were evaluated and a health economic analysis was performed. Results 165 patients with NAFLD without hepatic co-morbidity and excluding those undergoing bariatric surgery, and who attended ≥2 times between 2014–17, were followed from referral until latest review. Median follow-up was 13 months (2–34). At baseline, 29% had cirrhosis and 59% had T2DM. At follow-up, median liver stiffness, measured using transient elastography, decreased by 1.3 kPa (14%, p=0.0097) and was associated with significant improvement in alanine aminotransferase (ALT: −11IU/l, 21%, p 58 mmol/mol at baseline: 14 mmol/mol, 18%, p Preliminary economic analysis of our approach using the UKPDS Outcomes Model in patients with poorly controlled diabetes indicated improvement in quality adjusted life expectancy alongside a reduction in costs of complications if health improvements were maintained. Importantly, preliminary estimates appeared to be below the cost-per-QALY (quality adjusted life year) threshold of £20 000 for commissioning health interventions, suggesting a cost-effective approach. Conclusion Our Results demonstrate that the liver and cardio-metabolic health of patients with NAFLD managed through a multidisciplinary approach show significant improvements. Patients with poorly controlled T2DM had the greatest improvement in HbA1c of a magnitude known to reduce complications, which may potentially confer good benefit to patients in slowing NAFLD progression. Furthermore, our economic analysis suggest that this approach may be cost-effective.