Detection and treatment of liver condition may reduce societal costs significantly

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Keywords: cirrhosis, driving skills

Detecting and treating a late-stage liver condition called minimal hepatic encephalopathy may reduce societal costs by more than $3 million over five years, according to a new study led by researchers at Virginia Commonwealth University.

Minimal hepatic encephalopathy, or MHE, affects a large proportion of patients with chronic liver disease or cirrhosis. MHE is caused by the build-up of toxic substances that are normally removed by the liver. It is a reversible condition. It is associated with cognitive impairment, loss of consciousness and an increased risk of motor vehicle accidents.

In the study, published in the April issue of Hepatology, a journal of the American Association for the Study of Liver Diseases, the team conducted a cost-effectiveness analysis to determine whether it would save money in the long term to test people with cirrhosis for MHE and to treat those affected. This was compared to the current standard of care, which is to do nothing. The team used motor vehicle accidents as a benchmark complication of MHE and investigated whether different methods of diagnosing and/or treating MHE saved costs from a societal perspective. Read the journal’s release here.

“This is the first time that cost-analysis in cirrhosis and MHE has taken into account the needs and finances of the society,” said lead investigator Jasmohan Bajaj, M.D., associate professor of hepatology in the VCU School of Medicine and the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Va.

“This encourages practitioners to look beyond the individual patient with chronic liver disease and think of their environment and society also, rather than manage them in a vacuum,” he said.

Individuals suffering from MHE appear normal, but have severe problems with functioning, quality of life, employment and driving, that can only be detected through specialized testing. Since these tests require some dedicated time and effort, most doctors are not able to perform them as part of a patient’s clinic visit.

According to Bajaj, the team found that all diagnostic strategies had cost-saving benefits compared to not doing any diagnostic testing at all. A computerized test available at online known as the inhibitory control test was found to save the most money and impact society positively, in addition to subsequent treatment with a drug known as lactulose.

Bajaj collaborated with VCU colleagues Arun J. Sanyal, M.D., and Douglas M. Heuman, M.D., with the Division of Gastroenterology, Hepatology and Nutrition in the Virginia Commonwealth University School of Medicine and the Hunter Holmes McGuire VA Medical Center, and Steven D. Pinkerton, Ph.D., with the Medical College of Wisconsin in Milwaukee.

The work was supported in part by grants from the National Institute of Mental Health, the National Center for complementary and Alternative Medicine and the American College of Gastroenterology Junior Faculty Development Award grant.