Thursday, March 29, 2012
Detection and Treatment of Liver Condition May Reduce Societal Costs Significantly
Sathya Achia Abraham
VCU Communications and Public Relations
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
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.