LAUSR

Objectives: Liver function tests are widely used by GPs in UK. Abnormal results from these tests(ALFTs) are common, and are either left uninvestigated further– potentially overlooking curable liver disease which would otherwise be fatal, or associated with a lengthy process of retesting, referral, costing both the patient and the health services time and resources. iLFT is a semi-automated liver test cascading system with a structured diagnostic algorithm to maximise the efficiency of requesting LFTs. This study undertook a cost-effectiveness analysis of the iLFT decision tool compared to routine practice in Scotland, UK. Methods: 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 effect before and after intervention. 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 life-time analysis of 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). Results: The within trial analysis found costs to be £ 198.99 (95%CI 180.05, 217.94) and £260.14 (95%CI 190.93, 329.35) in routine practice and iLFT arms respectively. Probability of correct liver diagnosis was 0.41 (95%CI 0.37,0.46) in routine and 0.94 (95%CI 0.88,0.99) in iLFT, resulting in an ICER of £117.59 (95%CI 88,126) . The lifetime model found an incremental QALY gain of 0.99(95%CI .0843, .115) and a decreased cost of -31227.6(95%CI -31655.38, -30957.55at) , resulting in an ICER of £-312872. Conclusions: iLFT has a higher correct diagnosis rate and cost in short-term, in life-time model it dominates.