Extensive testing or focused testing of patients with elevated liver enzymes

Area of Science:

• Hepatology
• Diagnostic Strategies
• Health Economics

Background:

• Elevated serum aminotransferases indicate various liver conditions, necessitating diagnostic strategies.
• Clinicians face a choice between extensive (all-at-once) or focused (common diseases first) testing.

Purpose of the Study:

• To compare the cost-effectiveness of extensive versus focused testing strategies for elevated liver enzymes.
• To evaluate secondary outcomes including doctor visits, false-positives, and liver biopsies.

Main Methods:

• Simulation of 10,000 adult outpatients with elevated alanine aminotransferase.
• Utilized population-based data from the US and Britain.
• Primary outcome: cost in US dollars per diagnosis; secondary outcomes: visits, false-positives, biopsies.

Main Results:

• Extensive testing was cheaper ($448/diagnosis) and required fewer visits (1.35/patient) but yielded more false-positives (0.19/patient).
• Focused testing was more cost-effective when pre-test probabilities for specific liver diseases (e.g., alcoholic, NAFLD) were high.
• Focused testing also proved superior in referral settings with prior evaluations.

Conclusions:

• Deliberate and focused testing for elevated liver enzymes is recommended.
• Consideration of pre-test probabilities optimizes diagnostic strategy and resource utilization.