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Directed testing more cost effective in common liver disease cases

Directed testing for patients exhibiting signs of common liver diseases saves time, money and results in fewer false positives compared with non-directed testing, according to study results published in Journal of Hepatology.

“Doctors want to take the best care of their patients. There is a widespread perception that when it comes to liver testing, more is always better, but these data show otherwise,” Elliot Tapper, MD, MS, of the division of gastroenterology at the University of Michigan, told Healio.com/Hepatology. “Instead, it is the patient’s unique story and presentation that determines the appropriate amount of testing. Testing patients for rare diseases when they present all the clues for common diseases is more likely to expose them to the scare of a false-positive than an alternate diagnosis. We also show that ‘non-directed testing’ — which means choosing all the available tests for any conceivable liver disease — is very common but it does not lead to more diagnoses.”

Tapper and colleagues developed a probabilistic decision analytical microsimulation state-transition model to simulate 10,000 adult patients. They evaluated the patients for elevated liver enzymes. The model used disease prevalence estimates derived from population-based etiologic studies and monetary costs that reflected reimbursement prices, doctor visits, false positives and confirmatory liver biopsies.

Along the directed testing path, researchers evaluated patients for hepatitis C, hepatitis B, alcohol overuse by history and received abdominal ultrasonography. The non-directed testing also tested for hemochromatosis, autoimmune hepatitis, Wilson disease, alpha-1 antitrypsin deficiency and primary biliary cholangitis.

Non-directed testing results showed a diagnosis rate of 54% at a lower average cost of $447.84 per patient and an average of 1.35 doctor visits compared with the directed testing diagnosis rate of 53%, average cost of $502.40 per patient and average of 1.61 doctor visits. Directed testing, however, produced 0.1 false positive per patient compared with 0.19 in non-directed testing.

Directed testing was shown to be the more cost-effective strategy for cases in which pre-test probabilities were accounted and assessments for common liver diseases have already been performed, including cases in which the prevalence of alcoholic, non-alcoholic and drug-induced liver disease exceeds 51.1%, 53% and 13%, respectively.

“By accounting for the pre-test probabilities of liver disease and the prior evaluation performed, directed testing clearly reduces the risk of false positives while containing costs,” the researchers wrote. “Further study is needed to quantify the impact of efforts to guide directed testing within electronic ordering systems and extend these analyses to other clinical situations where non-directed testing is common.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.