Liver Function Panel (ALT, AST, ALP, GGT, Bilirubin)
Last reviewed 25 August 2026 · Evidence-graded review — see Methodology
Liver enzymes and bilirubin, screening for hepatocellular injury through ALT and AST and for cholestasis through ALP, GGT and bilirubin. The main quarry now is metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD), the most common liver disease in developed countries and firmly linked to cardiometabolic risk — alongside alcohol-related and other liver disease.
Elevated ALT is an established, if imperfect, screening flag for MASLD, which predicts progression to fibrosis and cirrhosis and correlates with cardiovascular risk. Professional guidance supports opportunistic case-finding in at-risk groups — obesity, diabetes, metabolic syndrome — rather than framing this as a universal population screen with its own independent evidence base.
Singapore guidance
Not covered in the current review
Singapore’s national screening committee has not reviewed this test in the current volume of its report, which covers nine conditions. That is not a verdict either way.
Source: Screening Test Review Committee report 2026, Volume 1 (Academy of Medicine Singapore and Ministry of Health, February 2026). The full national list · How this is used.
What you would actually pay
- Healthier SG
- Not subsidised
- MediSave
- Not among the screenings named for outpatient claims
Source: Healthier SG Screening (HealthHub) and MediSave outpatient care (Ministry of Health). Absence from either list is not a statement that the test is discouraged — only that no subsidy or claim applies. Gross prices compared.
What it costs when it is wrong
- Basis
- No published harm criterion found
- Severity
- Not documented
Not covered in the current volume of the committee’s report, so no harm criterion was found either way.
An empty finding, not a clean bill of health: this means nothing documented was found for this test. It is not a claim that the test is safe.
Screening harm is not only a laboratory question: the committee’s own criteria advise against a test when “the screening test, or follow-up tests arising from a positive screen, are associated with significant medical risks”. Sources on overdiagnosis → · How this is graded.
FAQ
Is the Liver Function Panel (ALT, AST, ALP, GGT, Bilirubin) worth doing in Singapore?
The evidence behind Liver Function Panel (ALT, AST, ALP, GGT, Bilirubin) is graded moderate for screening an asymptomatic adult. It is most appropriate for everyone, as part of a basic panel; particularly obesity, diabetes, alcohol use, or metabolic syndrome. It typically costs S$20–35 in Singapore. The usual schedule: every 1–3 years; annually with metabolic risk factors or hepatotoxic medications.
Weighing this against something else? Compare it with two other tests → · Price it inside a panel →