Abstract
Background: Liver function tests (LFTs) are frequently requested blood tests which may indicate liver disease. LFTs are commonly abnormal, the causes of which can be complex and frequently under investigated. This can lead to missed opportunities to diagnose and treat liver disease at an early stage. We developed an automated investigation algorithm, which would maximise early diagnosis of liver related diseases. Our aim was to determine whether this new pathway of care, Intelligent Liver Function testing (iLFT) increased diagnosis of liver disease and was cost-effective. Methods: By adjusting the current laboratory test order and communications systems we were able to produce an automated system to further analyse abnormal LFTs on initial testing samples. We integrated an automated investigation algorithm into the laboratory management system, based on minimal diagnostic criteria, liver fibrosis estimation, and reflex testing for causes of liver disease. This algorithm then generated a diagnosis and/or management plan. A stepped-wedged trial design was utilised to compare LFT outcomes in General Practices in the 6 months before and after introduction of the iLFT system. Diagnostic outcomes were collated and compared. Findings: Using iLFT, the diagnosis of liver disease was increased by 43%. It was cost-effective with a low initial incremental cost-effectiveness ratio (ICER) of £284 per correct diagnosis, and a saving to the NHS of £3,216 per patient lifetime. Interpretation: iLFT increases liver diagnosis, improves quality of care, and is highly cost-effective. This can be achieved with minor changes to working practices and exploitation of functionality existing within modern laboratory diagnostics systems. Funding: Chief Scientist Office, Scottish Government. Declaration of Interest: None declared. Ethical Approval: The study was approved by the East of Scotland Research Ethics committee.
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