Intelligent Liver Function Testing dominates standard care in diagnosing liver diseases

Intelligent Liver Function Testing (iLFT), an automated investigation algorithm for liver function tests (LFTs), is highly cost-effective, leading to higher rates of liver diagnoses and improvements in quality of care, according to a new study.

“It is clear that interventions that lead to early diagnosis and the opportunity to intervene and abate disease progression are needed,” said researchers. “ILFT delivers this opportunity in primary care to the general population at a minimal intervention cost, using existing infrastructure and utilising existing clinical pathways.”

The use of iLFT led to a significant 43-percent (95 percent CI, 27–59 percent; p<0.0002) increase in the rate of liver disease diagnoses. For example, the number of hepato-biliary diagnoses in the general practitioner (GP) records jumped from 16 percent before the intervention to 56 percent after. Majority of these additional diagnoses were from subgroups patients who had not been rechecked. [J Hepatol 2019;71:699-706]

The iLFT intervention also significantly increased the rates of GP visits both before (rate ratio [RR], 2.00, 1.37–2.91) and after (RR, 3.47, 1.63–7.36) diagnosis. Referrals to secondary care similarly increased (odds ratio [OR], 8.44, 1.99–35.73). Nonliver visits to the GP were reduced, though the difference was only of borderline significance.

ILFT had no significant effects on the number of nurse visits and blood requests. 

For the economic analysis, researchers also found that the iLFT intervention was significantly superior to the control at detecting liver disease and at identifying healthy people. This resulted in a 51-percent increase in the probability of delivering a correct diagnosis.

Within trials, iLFT came with an incremental cost per correct diagnosis of £284. However, lifetime models showed overall savings with iLTF of £3,216 per person, coupled with improved effectiveness. ILFT delivered a 0.021-unit increase in quality-adjusted life year.

“ILFT remains the dominant strategy across a wide range of willingness to pay thresholds, and at the UK threshold of £30,000 per QALY iLFT has a 100-percent probability of being cost-effective,” the researchers pointed out.

Physician feedback also supported the use of iLFT. Of 21 GPs who were surveyed, majority were positive about the intervention and wanted continued access. They found that it was easy to use and that it reduced their work load, despite the algorithm not always delivering concordant diagnoses. Overall, iLFT supported the GPs in reaching a diagnosis in 67 percent of the cases. Of these, a further 13 suggestions were discarded.

“Liver disease is increasing in incidence in contrast to many other conditions, predominantly driven by nonalcoholic fatty liver disease,” said researchers. “It disproportionately affects people under 65 years, leading to substantially increased morbidity and mortality.”

“The iLFT algorithm reduces future burdens of liver disease by allowing earlier interventions, guided by fibrosis scores which highlight those most at risk of future liver disease,” they continued. “This results in a dominant strategy, lifetime cost savings to the NHS and overall improvement in quality adjusted life year gains, due to this earlier detection.”

It’s worth noting, however, that the iLFT is costlier compared with the current clinical approaches, the researchers added. However, it is highly cost-effective such that the long-term savings that can be generated far outweigh its short-term, steep upfront costs.

“The iLFT system works, it increases liver diagnosis, is cost-effective and is clearly more effective at diagnosing liver disease than the standard of care,” the researchers said.