OBJECTIVES: The majority of bowel disorders exhibit a limited number of overlapping symptoms, making diagnosis very difficult in primary care. The inflammatory bowel diseases (IBD) are characterized by chronic inflammation of the gastrointestinal tract; the irritable bowel syndrome (IBS) is a functional disorder, with prevalence 10%-20% (Bellini, 2011). Endoscopy is considered as the gold standard procedure for detecting and quantifying IBDs, but due to the low prevalence of IBD (Molodecky, 2012), it turns negative in most of the cases, it is expensive, uncomfortable and risky for the patient. F-Calprotectin is a faecal marker of intestine inflammation; IBD patients exhibit F-Calprotectin levels significantly higher than the general population; IBS patients have F-Calprotectin levels significantly lower than IBD patients. Therefore, F-Calprotectin can be used as a pre-endoscopic technique to differentiate between IBD and IBS. We aim at evaluating the cost-effectiveness of F-Calprotectin tests compared to the standard pre-endoscopic tests (combined usage of serologic markers CRP - C-reactive protein - and ESR - erythrocyte sedimentation rate) to distinguish IBD from IBS in selected European markets (UK, SW, FR). METHODS: F-Calprotectin and CRP+ESR test accuracy was evaluated on existing data; the costs (diagnostic tests, diet, medications, and indirect costs) were collected from the literature. The analysis was tailored to children, teenagers and adults. The outcomes include cost avoidance, cost per corrected IBD diagnosed, and endoscopies reduction. Uncertainty was addressed with sensitivity analysis. RESULTS: Results show that the usage of F-Calprotectin is cost-effective with respect to CRP+ESR: a) it results in more corrected IBD diagnoses at a lower price (in UK it costs £50 less per adult patient than CRP+ESR), b) it reduces the number of unnecessary endoscopies. CONCLUSIONS: F-Calprotectin is a cost-effective methodology to rule out IBD at the primary care level, and it has a higher accuracy than CRP+ESR.