Detection of chronic liver disease: costs and benefits.

Alcohol abuse and chronic viral hepatitis B and C are the major etiologies of chronic liver disease in the United States. Both subspecialty and primary care physicians must become more knowledgeable about the epidemiology and risk factors for developing liver disease to effectively promote both prevention and early disease detection. Both abstinence from alcohol and interferon treatment of chronic viral hepatitis have been demonstrated to improve patient outcome; therefore, early interventions before liver function decompensates may decrease death and disability. Use of behavioral and biochemical screening tests is discussed in this context. Evaluation of patients with "asymptomatic liver test" abnormalities is a related problem that is also addressed. Finally, epidemiologic data and charge information for various liver tests are integrated to provide a framework for estimating the expense for detecting chronic liver disease of various etiologies. These expenses need to be balanced against the possible economic benefit from early disease detection or prevention.