Congratulations Jessica! Liver Fibrosis Screening Study Published in Scientific Reports

We are pleased to announce that our article, entitled Reimbursement restrictions reduce liver fibrosis screening in adults with diabetes in Ontario: a population-based interrupted time series analysis, has been published in Scientific Reports 🎉

Adults with type 2 diabetes are at increased risk of liver fibrosis, and current clinical guidelines recommend screening using the Fibrosis-4 Index (FIB-4). In this population-based cohort study, we examined whether modifications to Ontario Health Insurance Plan (OHIP) coverage for Aspartate Aminotransferase (AST) testing in 2013 were associated with changes in liver fibrosis assessment rates among adults with diabetes in Ontario, Canada. Using health administrative data from 2010 to 2022, we evaluated receipt of the laboratory tests required to calculate FIB-4: AST, alanine aminotransferase (ALT), and platelet count.

A total of 1,680,451 adults with diabetes and no prior history of liver disease were included in the study. Overall, the annual proportion of individuals who received no liver-related testing ranged from 39% to 47%. Compared to the pre-policy period, the likelihood of receiving all required laboratory tests for FIB-4 declined significantly during policy implementation (12.7% reduction), post-intervention (33.9% reduction), and during the COVID-19 period (63.1% reduction). Interrupted time series analyses also demonstrated an immediate decline in monthly liver fibrosis assessment rates following the reimbursement changes.

Our findings suggest that restricting AST reimbursement was associated with reduced liver fibrosis assessment among adults with diabetes, despite increasing consensus supporting preventative liver disease screening in high-risk populations. These results highlight how healthcare reimbursement policies can influence access to evidence-based preventive care and population health outcomes.

Congratulations Jessica Burnside, Dr. Sahar Saeed, and all co-authors on this incredible accomplishment! 🎉