F-CALPROTECTIN USE IN INFLAMMATORY BOWEL DISEASE IS CHARACTERISED BY IMPROVED DIAGNOSTIC ACCURACY, LESS PATIENT HARM AND DECREASED COSTS, COMPARED WITH CONVENTIONAL SEROLOGICAL MARKERS AND COLONOSCOPY. A SIMULATION STUDY IN THE NETHERLANDS ...
Author(s)
Mascialino B1, Wiertz R2, Vora AA3
1Thermo Fisher Scientific, Uppsala, Sweden, 2Thermo Fisher Scientific, Nieuwegein, The Netherlands, 3Thermo Fisher Scientific, Portage, MI, USA
OBJECTIVES: Gastrointestinal disorders may exhibit overlapping symptoms making diagnosis difficult in primary care. Inflammatory bowel disease (IBD - prevalence <0.5%) is a chronic inflammation of the gastrointestinal tract. Irritable bowel syndrome (IBS) is a functional disorder without gastrointestinal inflammation (prevalence of 10-20%). Endoscopy is the gold standard to diagnose IBD vs. IBS, but due to IBD’s low prevalence is negative in most of cases. Furthermore, colonoscopy is invasive, expensive, and uncomfortable for the patient and not without risks. F-Calprotectin (FC) is a fecal marker of intestinal inflammation. IBD patients exhibit FC levels significantly higher than the general population whereas IBS patients have FC levels higher than healthy controls, but significantly lower than IBD patients. Therefore, FC can be used as a pre-endoscopic test to differentiate between IBD and IBS. The present study evaluates the cost-effectiveness of a) FC compared to b) CRP+ESR, and c) colonoscopy to distinguish IBD from IBS in the UK and NL. METHODS: A Markov model was developed for each diagnostic strategy; using data from the published literature, 1.6% of the colonoscopies brought about complications, resulting in Emergency Room visits/surgery. Inadequate colon preparation (23%) and consequent repeated colonoscopies (30.3%) were also considered. Outcomes include cost savings, cost-per-corrected-IBD diagnosed, and colonoscopy reduction. Uncertainty was addressed with sensitivity analysis. RESULTS: In NL/UK, FC results in a lower price (average cost/patient: FC =751€/350£; CRP+ESR=1095€/561£; Colonoscopy=1022€/562£), and it reduces the number of unnecessary endoscopies (FC=736 colonoscopies avoided; CRP+ESR=722) and minimizes the associated complication costs, increasing the number of correctly diagnosed IBD (N=63) and IBS (N=26) patients. CONCLUSIONS: Results show that the usage of FC as pre-endoscopic diagnostic tool is associated with fewer colonoscopies and correctly identifies more disease while decreasing costs compared to the alternatives. Consequently, FC demonstrates superior value both from patient and payer perspective, while simultaneously increasing diagnostic efficacy.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PMD118
Topic
Epidemiology & Public Health
Topic Subcategory
Disease Classification & Coding
Disease
Gastrointestinal Disorders