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Faecal calprotectin delivers on convenience, cost reduction and clinical decision making in inflammatory bowel disease: a real world cohort study.

Intern Med J; 2018 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-29962008

BACKGROUND:

Faecal calprotectin (FC) is an accurate biomarker of disease activity in inflammatory bowel disease (IBD), yet the cost/resource implications of incorporating FC into 'real world' practice remain uncertain.

AIM:

To evaluate the utility of FC in clinical decision-making and on healthcare costs in IBD.

METHODS:

Retrospective data including colonoscopy/ other investigations, medication, admission and surgical data were collected from hospital records and compared between two groups: (1) pre-FC historical cohort (2005-09) where colonoscopy was used to assess IBD activity versus (2) FC was used first instead (2010-14). Post-test costs were also compared.

RESULTS:

357 FC tests (246 patients, 2010-14) and 450 colonoscopies (268 patients, 2005-9) were performed. At subsequent review, both FC and colonoscopy (in their respective cohorts) were associated with changes in management in 50.7 vs 56.2% respectively (p=0.14) with similar proportions of subsequent IBD-related investigations within 6 months (21.8 vs 21.9%, p=1.0). Prior FC availability (2005-09), colonoscopy for disease reassessment cost $AUD606,578 (cost per patient-year $1887.34) versus $AUD282,048 (cost per patient-year $968.60) when FC+/-colonoscopy was used (2010-2014). Within the FC cohort, 73.6% did not proceed to colonoscopy within 6 months post-FC, 60.6% had not undergone colonoscopy post-FC by end of follow-up (median 1.8y (0.1,4.6) post-FC). Those with FC≥250 were scoped earlier than those with FC<100 µg/ml (median 0.49 vs 1.0 years, p=0.03).

CONCLUSIONS:

Introduction of FC into routine IBD care aided changes in clinical management in a similar proportion, yet at potentially half the total cost, compared to a historical colonoscopy-only cohort at the same centre. This article is protected by copyright. All rights reserved.