Improving patients’ experience of care and reducing costs to the NHS are central to EMAHSN’s clinical programmes. Our Scarred Liver project is delivering on both of these; improving outcomes through identifying people at risk of liver disease earlier whilst averting the on-costs of care and treatment.

Working in partnership with the NIHR Nottingham Digestive Diseases Centre BRC, we have supported the roll out of an innovative diagnostic pathway and the use of the mobile Fibroscan® device. This initiative is being led by Professor Neil Guha and his team, and is proven to more effectively detect chronic liver disease at an early stage.

The liver is the largest organ in the body and essential for fighting infection, destroying poisons, cleaning the blood, controlling cholesterol and processing our digested food. Disease of the liver is often ‘silent’ as it compensates for the damage we do to it and there are often no presenting symptoms until it is too late.

The Fibroscan® is a simple, painless test using ultrasound that measures the degree of inflammation in your liver. It is non-invasive as it replaces the need for a biopsy. Results are immediate, allowing you to agree a treatment plan with your clinician and get support in making positive lifestyle changes to reduce the risk of liver disease developing or advancing.

Although there are many causes, the three main threats to liver health are alcohol consumption, non-alcohol related fatty disease and viral hepatitis.

Nearly a quarter of us are drinking more than the recommended weekly amount and statistics related to alcohol and liver disease show that alcohol misuse is the biggest risk factor for death, ill-health and disability among 15 to 49 year-olds in the UK. And liver disease is on the increase - with one in five of us now at risk of the disease.

Campaigns for system-wide changes are gaining ground; raising awareness of liver disease and prevention so that fewer of us will suffer long-term damage. This is really important because liver disease can be halted and, in some cases, even reversed if lifestyle changes are made at an early stage.

Our Scarred Liver programme has been running since 2014 and the pathway has now been implemented across Nottingham, Leicester and Chesterfield with plans to start screening this month at a GP super-practice in South Lincolnshire. In total 3485 people identified at risk of liver disease have been screened and 715 people have been found to be at risk of significant liver disease – cases that would otherwise have gone undetected.

A health economics report concluded implementing the pathway not only provided better outcomes for patients but also that costs were significantly within the NICE threshold of £20,000 per quality-adjusted life-year (QALY). Amazingly these came in at at £2,138 per QALY for non-alcoholic fatty liver disease (NAFLD) and £6,537 per QALY for alcoholic liver disease (ALD). The project’s success has contributed to the revision in July 2016 of NICE clinical guidance for liver cirrhosis (NG50) and NAFLD (NG49).

Programmes like Scarred Liver are a vital component of the prevention agenda and we estimate that around 12 million people could be identified as being at risk if this programme was scaled throughout England and Wales.

This type of diagnostic has the potential to make a real difference in halting the progress of liver disease or even helping people make a full recovery before it’s too late. And of course, we can all help ourselves too, maybe using Alcohol Awareness Week as the starting point for change?

For more information on liver disease and liver health visit www.britishlivertrust.org.uk 

Author

Dr Fiona Kilpatrick - Scarred Liver Project Manager

Fiona supports the implementation of a variety of innovations including Scarred Liver, FaHRAS and provides support to the PReCePT project.

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