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Automated liver function test cost-effectively increases correct diagnoses

Use of an automated investigation algorithm known as intelligent liver function testing increased liver disease diagnoses and improved patient quality of care in a cost-effective manner, according to a study published in Journal of Hepatology.

The intelligent liver function test (iLFT) system uses a minimal range of robust diagnostic criteria and was designed to fail safe, defaulting to further clinical evaluation in cases of diagnostic uncertainty. The crucial point for determination is the degree of liver fibrosis or cirrhosis.

“Liver disease is increasing in incidence in contrast to many other conditions, predominantly driven by [nonalcoholic fatty liver disease],” John F. Dillon, MD, from the University of Dundee in the United Kingdom and colleagues wrote. “It is clear that interventions that lead to early diagnosis and the opportunity to intervene and abate disease progression are needed. iLFT delivers this opportunity in primary care to the general population at a minimal intervention cost, using existing infrastructure and utilizing existing clinical pathways.”

The study comprised a control group of 490 patients and an intervention group of 64 patients all of whom had abnormal LFTs. iLFT supported the general practitioner to a diagnosis in 67% of cases with 13 cases discarded for either an alternative diagnosis (n = 6) or no diagnosis (n = 7).

iLFT increased the rate of liver disease diagnosis by 43% (95% CI, 27%-59%) in the intervention group compared with controls, increased the rate of visits to the general practitioner before diagnosis (relative risk = 2; 95% CI, 1.37-2.91) and after diagnosis (RR = 3.47; 95% CI, 1.63-7.36), and increased referral to secondary care (OR = 8.44; 95% CI, 1.99-35.73).

Use of iLFT during the study resulted in an incremental cost per correct diagnosis of 284 British pounds. In the lifetime model, iLFT resulted in a cost saving of 3,216 British pounds per person and improved effectiveness with an increase of 0.021 in quality-adjusted life years. Based on the U.K. willingness to pay threshold of 30,000 British pounds per QALY, iLFT demonstrated 100% probability of being cost-effective.

“The iLFT algorithm reduces future burdens of liver disease by enabling earlier interventions, guided by fibrosis scores which highlight those most at risk of future liver disease,” Dillon and colleagues concluded. “The short-term additional costs are outweighed by the long-term savings to the NHS through earlier identification of [alcohol-related liver disease] and NAFLD.” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.