By Tom Moberly, 14 March 2011:
The University of Birmingham team said repeating abnormal liver function tests before checking for viral hepatitis, as recommended by current guidelines, was not supported by their analysis.
‘It is the most expensive option, both in absolute terms and in terms of cost per case detected,’ they said.
The researchers also found that testing all patients who have an abnormal liver function and were born in countries where viral hepatitis is prevalent was efficient.
They used their findings to produce a ‘fast and frugal’ strategy to guide GPs in diagnosing viral hepatitis in asymptomatic patients with abnormal liver function test results.
The researchers recommend testing all patients where a clear clinical indication of infection is present, then all patients who originated from countries where viral hepatitis is prevalent. Also any patients with an alanine aminotransferase level more than twice the upper limit of normal should be tested, they said.
‘Our results suggest that the cost of automatic testing of high-risk individuals will be repaid in terms of additional cases detected,’ they said.
‘Patients not picked up by this efficient algorithm had a risk of chronic viral hepatitis that is lower than the general population,’ they concluded.
‘However, this should not override clinical judgement,’ they said.
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