VCU team finds that simple liver screening to catch treatable cause of “dementia” is cost-effective
A new study shows a cheap blood test and a follow-up plan could identify people who are being treated as if they have dementia but actually have a treatable liver problem could save the system thousands of dollars.
What the researchers found
Some people diagnosed with dementia may have cirrhosis, a severe scarring of the liver, that can lead to cognitive changes called hepatic encephalopathy. HE can make thinking and memory worse, but it can be easily treated and reversed, unlike dementia. Identifying reversible causes of brain function, and the approaches that save money, is critical.
The study, published in the American Journal of Medicine, compared seven ways to find and treat HE in people thought to have dementia. The researchers used a computer model to simulate outcomes using published data and assumptions instead of studying real people.
Of the seven methods, the best plan used the FIB-4 blood test to check for liver scarring, sent those with high scores to a liver doctor, and treated patients who needed it with a medicine called lactulose.
The results
- Five of six new plans worked better and cost less than doing nothing.
- The top plan saved about $9,414 per patient and gave a small health boost.
- A similar plan that gave lactulose right after the FIB-4 test saved slightly more money but helped a little less.
- Using a more expensive medicine, rifaximin, still helped but saved less money.
- Treating everyone without testing didn’t work well: giving lactulose to all caused more harm because of side effects, while giving rifaximin to all saved only a little.
Why this matters
Doctors sometimes miss HE because its symptoms look like dementia. Using a simple test and targeting treatment could stop wrong diagnoses, cut health-care costs, and help some people regain thinking skills. The study looked at just one year, so long-term benefits might be even bigger.
A careful step
The researchers say the FIB-4 can be affected by age, so they used strict thresholds to avoid mistakes in very old patients. They also note that seeing a liver specialist after patients receive a high FIB-4 score helps confirm whether treatment is really needed.
Adding a low-cost liver screen and follow-up care to the existing dementia checkups could find treatable cases and save money, giving some people a chance to get better instead of being labeled with irreversible dementia.
The study’s co-first authors were gastroenterology fellow Vinay Jahagirdar, M.D., of VCU and the Richmond Veterans Affairs Medical Center, and health economist Vasco M. Pontinha, Ph.D., of VCU’s School of Pharmacy. Other authors included VCU geriatricians Laura R. Lawson, M.D., and Michael Godschalk, M.D., and gastroenterologist and corresponding author Jasmohan S. Bajaj, M.D., of VCU and the VA medical center. The research was partly supported by VA Merit Review I01CX002472.