LiverPRO reduces false positives and screening costs compared with Fibrosis-4 Index in steatotic liver disease
What pressing problem did this study address?
Steatotic liver disease (SLD) has a very high prevalence across the adult population, however, only a small fraction of those affected by SLD will develop severe complications. FIB-4, the current test to detect SLD has a limited accuracy and leads to many unnecessary referrals and high healthcare costs.
What did this study find?
This study compared FIB-4 with LiverPRO in more than 4000 individuals at risk of SLD from a Danish screening cohort. Each test was evaluated based on how well patients with liver fibrosis were identified and how efficiently healthcare resources were used.
The findings showed that:
- Testing with FIB-4 leads to high referral rates (23-32%)
- Testing with LiverPRO leads to much lower referral rates (9%) with higher specificity (94%)
- Testing with LiverPRO can save up to €1 million per 10,000 people tested
- Costs are approximately 32% lower per detected case
- Trade-off: LiverPRO missed more fibrosis cases than FIB-4. This study used the high cut off (65%) for LiverPRO, designed to only refer high-risk patients for further testing.
This research letter highlights that LiverPRO can help make liver disease screening more efficient and cost-effective by reducing false referrals to specialist clinics.
Abstract
Targeted screening for steatotic liver disease (SLD) is cost-effective and encourages lifestyle changes. The European Association for the Study of the Liver (EASL) recommends screening adults at risk of SLD to enable timely diagnosis and prevention, especially with emerging treatments like resmetirom and semaglutide. EASL guidelines suggest the fibrosis-4 index (FIB-4) as the first-line noninvasive test to identify candidates for secondary care referral with more accurate, resource-intensive assessments like liver stiffness measurements by transient elastography (TE).