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GPs could ‘reduce harm’ and save NHS £8m by using single liver function test



GP practices could reduce potential harm from over-testing and save the NHS millions if CCGs helped them to cut out unnecessary liver tests in their patients on statins, a study in East London has revealed.

GPs in NHS Tower Hamlets CCG were given the option of ordering a single alanine transaminase test (ALT) to test liver function in patients on statins, instead of the usual full array of seven tests, in new local guidance put in place in 2014.

An advisory panel of GPs, hepatologists and laboratory staff developed the guidelines, working on the basis that the ALT is one of the most useful tests for determining liver disease, and that overuse of the full array of liver function tests (LFTs) could cause patients harm from false positive results.

Researchers from Queen Mary University of London observed that after a year of this intervention, GPs were ordering significantly fewer full LFTs for patients on statins.

The rate of ordering fell by almost a quarter, from 70 tests per 1,000 patients in the pre-intervention year to 58 tests per 1,000 in the year after. Meanwhile, the number of ALTs ordered increased almost 10-fold.

By contrast neighbouring NHS Newham CCG, where GPs were not advised about the single ALT test, saw an increase in total number of LFTs ordered during the observation period.

The team calculated that in Tower Hamlets the reduction in full LFTs costing £45.50 each, offset by additional ALTs costing just £6.50, resulted in an overall saving of £130,435 to the CCG.

By comparison, the cost of LFTs went up by £9,158 over the same period in Newham.The researchers estimated that the NHS could save over £8m per year if every CCG in England reduced their amounts of LFT ordering by just 20%, offset by the increased ordering of ALTs.

The team concluded: ‘For patients, fewer blood tests will result in fewer false positive results, unnecessary testing, and patient anxiety.

‘For providers it decreases laboratory costs, phlebotomy, and clinical staff time.’

Br J Gen Pr 2017; available online 30 January