Liver disease support for GPs
News release from the National Coordinating Centre for Health Technology Assessment
16 September 2005
Two research projects aiming to develop ways to help doctors in the management of patients with suspected liver disease have been commissioned by the HTA programme. The two projects aim to expand the science base around the disease, which is responsible for more than 8,000 deaths annually in the UK, establishing the best ways to evaluate liver function and identify preventable liver disease at an early stage.
The £163,000 Abnormal Liver Function Investigations Evaluation (ALFIE), which is being run by a research team from the Health Informatics Centre of the University of Dundee, aims to develop a decision support tool for use in the primary care management of patients with abnormal liver function tests (LFTs) but who have no clinically apparent liver disease. LFTs are frequently performed when patients have symptoms that are hard to ascribe to a particular disease, such as tiredness and weight loss, and sometimes the tests are even ordered to prompt a change in life style of someone suspected of drinking too much. The study will analyse the characteristics of people with abnormal LFTs recorded in a database over 14 years (taking in 400,000 patients), to establish who did and who did not develop liver disease. By identifying the characteristics of people who went on to develop liver disease, it is hoped that the findings of the study will help with the identification of preventable liver disease at an early stage, reducing the need for unnecessary further investigations in many patients. The findings, which are due for publication in 2008, will be used to develop a computerised clinical decision support tool to inform doctors in their treatment of patients with abnormal LFTs.
“Liver function tests (LFTs) are routinely performed in primary and secondary care, and are often the gateway to further invasive and/or expensive investigations,” explains lead researcher Dr Peter Donnan. “Yet little is known of the consequences in people with an initial abnormal liver function (ALF) test. By establishing a way to identify which of these patients is at risk of liver disease we hope to reduce the number of unnecessary investigations that are carried out, as these can be dangerous for the patient and expensive for the NHS.”
The BALLETS project (Birmingham and Lambeth Liver Evaluation Testing Strategies) is also targeting liver disease, aiming to find out more about the results of LFTs and their implications. Taking in a range of factors including the patient’s clinical features, the £530,000 study, which is due to complete in 2011, aims to show which combination of initial and subsequent investigations yield the highest chance of getting the correct diagnosis. The ultimate goal is to establish the best overall strategy for liver function testing, one which limits the number of test visits a person needs, shortens the period of anxious waiting and is economical with health budgets.
“BALLETS is a prospective study in which a large group of people with abnormal LFTs will be followed up using a standard and comprehensive protocol of initial investigations,” says lead researcher Professor Richard Lilford. “Statistical analysis will then be carried out to show which combinations of clinical findings and laboratory results indicate serious disease and should be investigated further.”
“Liver disease is responsible for over 8,000 deaths annually in the UK,” says Professor Tom Walley, director of the HTA programme. “We are not clear how many patients suffer with liver disease – it may be as many as one million – and yet little is known about the imprecise science of liver testing. We need to know how best to detect early liver disease in the most clinically effective and cost effective way, without exposing patients to unnecessary and even harmful investigation. We have commissioned these two complementary studies to determine how we can identify preventable liver disease at an early stage while reducing unnecessary testing of people at low risk of the disease.”
Notes for editors
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The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with more than 400 issues published to date. The journal’s 2007 Impact Factor (3.87) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk The HTA programme is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.
- The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk
Contact details
Naomi Stockley, Programme Manager (Communications)
Telephone: 02380 595 646, Email: ns5@soton.ac.uk
Helen Nikandrou, Assistant Programme Manager (Communications)
Telephone: 02380 595 584, Email: h.nikandrou@soton.ac.uk
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