SAT-446 - Making sense of liver function tests: Is the Intelligent Liver Function Test (iLFT) cost-effective?

Abstract

Background and Aims: Liver function tests are widely used by GPs in primary care to identify liver disease. Abnormal results are common though, and are followed by (i) a lengthy process of retesting and referral which is costly to both patients and health services, or (ii) are left uninvestigated – potentially overlooking curable liver disease which would otherwise be fatal. iLFT is a semi-automated liver test cascading system with a structured diagnostic algorithm to maximise the efficiency of requesting LFTs and improve diagnosis. This study undertook a cost-effectiveness analysis of the iLFT decision tool compared to routine practice in Scotland, UK. Method: An economic evaluation alongside the trial, and lifetime model undertaken from the perspective of NHS of Scotland. A step wedge design trial was carried out which compared effectiveness of diagnosis before and after the introduction of the iLFT system. Within trial outcomes are reported as incremental cost per correct diagnosis at six months follow up, while a Markov model was used to extrapolate out to a lifetime analysis with discounted costs and quality adjusted life years gained in each arm, to account for early detection of Alcoholic Liver Disease (ALD) and Non-alcoholic Liver Fatty liver Disease (NAFLD). Probabilistic sensitivity analysis was undertaken with a 1000 iteration monte carlo simulation. Results: The within trial analysis found costs to be £185 (CI 95% £166, £202) and £328 (CI 95% £231, £425) in routine practice and iLFT arms respectively. Probability of correct diagnosis (true positive and true negative)was 0.41 (CI 95% 0.37, 0.45) in routine and 0.92 (95% CI 0.85, 0.99) in iLFT, resulting in an ICER of £284 (CI 95% £128, £440). The lifetime model found iLFT to dominate routine practice with an incremental cost saving of £3216 (CI 95% -£7643, -£897) and an incremental QALY gain of 0.021 (CI 95% 0.009, 0.04). Conclusion: iLFT increases Liver diagnosis, while improves quality of care and is cost effective with a lowICER of £284 per correct diagnosis and over a patient lifetime is a dominant strategy saving the NHS an average £3,216 per patient. Given these results iLFT should be recommended and widely implemented across the NHS.