Introduction of Faecal Calprotectin Testing Into the UK Inflammatory Bowel Disease Diagnostic Pathway Reduces Environmental Burden

OBJECTIVES: Inflammatory bowel disease (IBD) encompasses Crohn’s disease and colitis, which are chronic illnesses with a high healthcare resource use and environmental burden. The prevalence of IBD is rising, making timely and improved diagnosis increasingly important. The IBD diagnosis pathway involves several diagnostic tests and substantial use of physician time and healthcare resources, contributing significantly to environmental burden.

Although faecal calprotectin (FCP) testing for IBD diagnosis in the primary care setting is recommended by the National Institute for Health and Care Excellence (NICE), uptake in clinical practice has been limited. FCP testing reduces secondary care referrals and endoscopic investigations. This study investigated the potential carbon emission savings from implementing FCP testing for IBD diagnosis.

METHODS: The UK IBD diagnosis pathway was mapped over one-year according to current clinical practice and NICE guidelines (DG11). Carbon emissions associated with general practitioner visits, accident and emergency visits, hospital admissions, secondary care visits and travel were sourced from the Sustainable Healthcare Coalition (shcoalition.org). Carbon emissions for diagnostic tests (magnetic resonance imaging, computed tomography, ultrasound, endoscopy) were derived from published literature.

RESULTS: The total environmental cost associated with the current diagnosis pathway for IBD over one-year in the UK was estimated at 4,606 tonnes of carbon dioxide equivalents (CO₂e). Published literature suggests that implementation of FCP testing in primary care could reduce secondary care referrals by 35.37%, and endoscopic investigation by 63.80%. Therefore, following NICE recommendations to introduce FCP testing could result in a reduction of 490.78 tonnes CO₂e annually, equivalent to a 10.65% reduction in CO₂e compared to the current diagnostic pathway. This carbon saving is comparable to the average annual energy usage of 64 households.

CONCLUSIONS: Introducing FCP testing into the primary care setting for IBD diagnosis could significantly reduce environmental impact by avoiding unnecessary secondary care referrals and endoscopic investigations.