自动化肝功能测试可以经济有效地增加正确的诊断

StephenW

Automated liver function test cost-effectively increases correct diagnoses

Dillon JF, et al. J Hepatol. 2019;doi:10.1016/j.jhep.2019.05.033.
August 13, 2019

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.

StephenW

自动化肝功能测试可以经济有效地增加正确的诊断

Dillon JF，et al。 J Hepatol。 2019; DOI：10.1016 / j.jhep.2019.05.033。
2019年8月13日

根据发表于Journal of Hepatology的一项研究，使用称为智能肝功能检测的自动调查算法可以经济有效的方式增加肝病诊断并提高患者的护理质量。

智能肝功能测试（iLFT）系统使用最小范围的稳健诊断标准，旨在确保故障安全，默认为诊断不确定性情况下的进一步临床评估。确定的关键点是肝纤维化或肝硬化的程度。

英国邓迪大学的John F. Dillon博士及其同事写道：“与许多其他疾病相比，肝脏疾病的发病率正在增加，主要是由[非酒精性脂肪性肝病]引起的。” “很明显，需要进行早期诊断的干预措施以及干预和减少疾病进展的机会。 iLFT利用现有的基础设施和利用现有的临床路径，以最小的干预成本为普通大众提供初级保健机会。“

该研究包括490名患者的对照组和64名患者的干预组，所有患者均有异常LFT。 iLFT支持全科医生对67％的病例进行诊断，其中13例因替代诊断（n = 6）或无诊断（n = 7）而被丢弃。

与对照组相比，iLFT将肝病诊断率提高了43％（95％CI，27％-59％），提高了诊断前全科医生的就诊率（相对风险= 2; 95％CI） ，1.37-2.91）和确诊后（RR = 3.47; 95％CI，1.63-7.36），并增加转诊到二级保健（OR = 8.44; 95％CI，1.99-35.73）。

在研究期间使用iLFT导致每次正确诊断的增量成本为284英镑。在终身模型中，iLFT节省了每人3,216英镑的成本，并且在质量调整生命年中增加了0.021，提高了效率。根据英国愿意支付每QALY 30,000英镑的门槛，iLFT证明100％具有成本效益的可能性。

Dillon及其同事总结道：“iLFT算法可以通过早期干预来减少肝脏疾病的未来负担，这些干预措施由纤维化评分指导，这些评分突出了未来患肝病的风险。”通过早期识别[酒精相关性肝病]和NAFLD，可以为NHS的长期储蓄抵消短期额外费用。“ -  Talitha Bennett

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