What is the most efficacious, aceptable and cost effective way to screen for liver disease in the community?

Funding:

BNSSG ICB Research Capability Funding.

What is the problem?

90% of all liver disease can be prevented and is either due to alcohol, obesity or viruses. Despite this, whilst all the other big causes of death fall, deaths due to liver disease continue to rise. Liver disease has now overtaken suicide as one of the main causes of death in people of working age in the UK. Alcohol, obesity and viruses can damage the liver, causing it to scar (fibrosis). When that scarring cannot be reversed it is called cirrhosis. Once patients have cirrhosis they are at much higher risk of complications, such as confusion, the tummy swelling with fluid, or bleeding from the gut. However, if cirrhosis, or bad liver scarring (fibrosis) is picked up early, it allows doctors to start treating patients. Treatment includes support with lifestyle changes, starting medication and monitoring patients for liver cancer. The hope is this stops patients developing complications.

Currently, patients need their GP to suspect they have liver disease to test for it. The problem is patients will not have symptoms until they have complications of cirrhosis.

We have good tests to detect liver disease and cirrhosis including blood tests and special liver scans. What we don’t know is (1) the best way to order these tests, (2) what is the most cost efficient way to test people (3) what will detect the most liver disease, and (4) what pathway is easiest for patients to follow.

What is the aim of the research?

The overall aim is to design a trial to test people for liver disease in the community and compare that testing to the normal care patients receive now. The trial would be run using multiple GP practices across the country.

We would then test if it is cheaper overall to test people for liver disease in the community in this way.

How will this be achieved?

Stage 1 – 12 months trial. 38 GP practices across the country will be invited to take part. Each practice will be randomly selected to be in the “intervention arm” or the “control arm”.

Within the “intervention arm”, a random selection of patients who meet criteria to be in the trial will be invited to be screened for liver disease with blood tests, liver scans, and additional health questionnaires. Questions asked will include amount of alcohol consumed and other health conditions that patients may have. These patients will be followed up for 1 year.

Patients who meet criteria will need to be between 40 and 75 years. They will need to either have high liver blood tests, or a history of excessive alcohol intake, or type 2 diabetes or have obesity. Patients who already have known liver disease, cancer or who are terminally ill will not be included in the trial.

We will follow patients recruited to the “control arm” for 1 year to see if they are referred to liver services.

Stage 2 – Analysis. Once we have the information from the 12 month trial, we will use that information to answer:

1. How much cirrhosis was found.
2. How much of the referrals did not have severe liver disease
3. How many patients that were referred went on to be admitted with liver complications in the first year.
4. Was it less costly to detect liver disease through the trial compared to the current standard of care.
5. Did patients think the trial pathway was ok.

Who is leading the research?

Dr Kushala Abeysekera, Academic Clinical Lecturer in Public Health and Epidemiology: Gastroenterology, Bristol Medical School.

Further information

About Dr Kushala Abeysekera.

For more information or to get involved with this project, please contact bnssg.research@nhs.net.