Introduction

Liver disease in the UK has become a critical public health concern, with mortality rising by nearly 40% over the past two decades. In 2022, liver disease caused over 10,500 premature deaths, underscoring a growing health crisis. Hospital admissions due to liver disease have also surged, with over 85,000 cases recorded in England in the financial year ending 2023—reflecting a nearly 47% increase over the past decade.

The condition primarily affects individuals have approached middle age, with those aged 45 to 64 representing the largest portion of liver disease-related deaths. Many patients are diagnosed only once their liver disease has reached an advanced, symptomatic stage, particularly in cases of decompensated cirrhosis. In this severe phase, liver function is highly compromised, requiring regular hospital visits to manage complications like fluid build-up, bleeding, and infections. This situation not only impacts patient quality of life but also places a substantial burden on NHS resources.

Health Economics Impact of Liver Disease

The cost of liver disease to the NHS is substantial, with estimates in recent years suggesting it could exceed £3.5 billion annually. Direct costs stem from hospital admissions, liver transplants, and ongoing treatment, while indirect costs arise from lost productivity and the broader impact on public health services.
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A few key points about these costs:

1. Hospital Admissions: Liver disease accounts for tens of thousands of hospital admissions yearly, with a high rate of readmissions and prolonged hospital stays for severe cases.
2. Liver Transplants: Transplants are costly, with each procedure costing the NHS between £50,000 and £100,000, not including post-operative care and lifelong medications.
3. Ongoing Treatments: Treatments for complications like cirrhosis, infections, and liver cancer add significant, recurring expenses.
4. Growing Trend: The NHS has seen a marked rise in liver disease cases, partly due to lifestyle factors, which means the future cost is projected to increase unless there are substantial preventative measures or interventions.

For information on the costs associated with liver disease in the NHS, including hospital admissions and treatment costs, here are some resources:

1. UK Health Security Agency (UKHSA) has a detailed breakdown of liver disease trends, including hospital admissions due to alcoholic liver disease. This analysis covers cost implications from increased admissions, which have risen sharply, partly due to lifestyle factors like alcohol consumption and obesity. UKHSA suggests that hospital admissions related to liver disease have seen a significant increase, impacting NHS resources due to the complex and recurring nature of treatment needed for advanced liver conditions. Read more here.
2. Public Health England (PHE) reports on the broader costs of multi-morbidity, including liver disease, as one of the prominent long-term conditions driving NHS expenses. Liver disease, in particular, has shown substantial cost burdens due to the need for emergency care and long-term treatments. For a deep dive into multimorbidity and associated healthcare costs, see their report on disease costs.
3. NHS Liver Disease Profiles provide data on liver disease admissions and mortality rates across the UK. These profiles highlight the economic and social impact on the NHS, with admission rates for liver-related diseases showing marked regional variation. The profiles help outline trends and provide cost insights for different types of liver disease, such as alcoholic liver disease. Access the latest profiles here.

The Challenge

Patients with decompensated liver disease face considerable challenges in managing their condition, both within the healthcare system and on a personal level. In healthcare settings, treating this condition is complex and resource-intensive, with patients often experiencing complications that demand immediate intervention, such as fluid accumulation, infections, or gastrointestinal bleeding. These complications frequently result in hospital admissions and lengthy stays, adding significant strain to NHS resources, particularly as the number of liver disease cases continues to rise in the post-COVID era. The clinical capacity is already severely strained/pressured, and limited access to liver specialists further hinders proactive management, leading to delays and missed opportunities for early intervention.

For the patient, living with decompensated liver disease can mean a continuous cycle of hospital visits and re-admissions, creating physical, mental, and financial burdens. The uncertainty surrounding symptom escalation—due to a lack of continuous monitoring—leaves many patients anxious about their condition and their ability to manage it. This reactive approach to care often means that treatment only begins once symptoms worsen, adding to the emotional and logistical stress they face. Frequent hospitalisations interrupt daily life, work, and family obligations, impacting quality of life and adding to the overall toll of managing this chronic, severe condition.

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The Solution

To address the complex needs of patients with decompensated liver disease, Royal London Hospital and Barts Health NHS Trust partnered with Doccla to create an innovative Remote Patient Monitoring (RPM) pathway that extends specialist care into patients' homes. This collaboration was focused on developing a clear, effective protocol that prioritised both patient safety and clinical efficacy, with established inclusion and exclusion criteria.

The inclusion criteria targeted patients with decompensated cirrhosis who required close monitoring but had manageable symptoms and stable home conditions, ensuring they could benefit from RPM. Exclusion criteria considered factors such as severe comorbidities or unstable housing, ensuring that remote care was used safely and effectively for those best suited to it.

Together, Royal London Hospital and Barts Health NHS Trust and Doccla developed a patient-centered RPM model that enabled proactive, data-driven engagement with high-risk patients. This pathway allowed healthcare teams to detect early signs of deterioration and respond before symptoms escalated, reducing the need for emergency hospital readmissions and easing the burden on NHS resources, all while providing patients with access to a care continuum that helped them feel reassured and looked after.

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The Outcomes

1. 50% Reduction in Liver-Related Deaths at 90 Days: The RPM group had a liver-related mortality rate of 5% compared to 10% in the control group.
2. 6% Reduction in Clinic Follow-Ups: Patients in the RPM group had 6% fewer clinic follow-ups than those in the control group, indicating a decrease in the need for in-person consultations.
3. Significant Increase in Planned Procedures (LVPs): 65% of RPM patients underwent planned Large Volume Paracentesis (LVP) procedures compared to 15% in the control group, suggesting improved management and fewer emergency interventions.
4. 57% Reduction in Emergency Admissions: Only 12% of the RPM group required emergency admissions, compared to 28% in the control group.
5. 29% Reduction in Decompensated Patients at 30 Days: At the 30-day mark, 58% of the RPM group remained decompensated versus 87% in the control, showing a substantial reduction in decompensation severity.
6. 20% Increase in Recompensated Patients at 90 Days: By 90 days, 26% of the RPM group achieved recompensation compared to 6% in the control group, reflecting an improvement in recovery rates.

Results summary

Key Learnings

• Proactive Monitoring Reduces Emergency Interventions: The study demonstrated that Remote Patient Monitoring (RPM) enables a shift from reactive emergency care to proactive, planned interventions. By allowing continuous monitoring, RPM helped reduce emergency admissions and increased the proportion of planned procedures, proving that early detection and intervention can significantly reduce unplanned healthcare needs.
• Improved Patient Outcomes Through Continuous Support: RPM was associated with a substantial decrease in liver-related deaths and a higher rate of patient recompensation. This supports the hypothesis that virtual care models offering continuous oversight can enhance patient stability, reduce mortality, and contribute to better long-term health outcomes for patients with chronic conditions like decompensated liver disease.
• Operational Efficiency Gains: The study showed a reduction in clinic follow-ups, indicating that RPM can optimise healthcare resource use by reducing the demand for in-person visits. This proves the hypothesis that RPM can relieve pressure on healthcare facilities, enabling clinicians to prioritise patients who require intensive in-person care.
• Enhanced Patient Engagement and Self-Management: The RPM model increased patient engagement by involving them in daily health monitoring, empowering them to take a more active role in managing their condition. This result supports the hypothesis that virtual care can foster better patient adherence and engagement, which are critical for managing chronic, high-risk conditions.

Conclusion‍‍

The success of this Virtual Care model for decompensated liver disease establishes a meaningful shift in the standard of care, demonstrating how continuous, at-home support can bring stability, safety, and relief to patients. In collaboration with Royal London Hospital and Barts Health NHS Trust, this approach exemplifies the profound impact that virtual care can have on both individual outcomes and NHS efficiency. By reducing mortality, enhancing patient stability, and decreasing readmission rates, this model underscores a new way forward for healthcare systems striving to meet the growing demands of chronic, high-risk conditions.

As liver disease prevalence rises, expanding virtual care across the NHS could enable more sustainable, proactive care for patients navigating this challenging condition. This study provides a path for healthcare leaders to consider virtual care as a scalable, patient-centered solution to improve outcomes and preserve NHS resources. You can read more about the full study in the BMJ here.