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P206. Is the IBD pre-endoscopic screening F-Calprotectin test more cost-effective than the usage of serologic markers in selected European markets?

B. Mascialino1, L.-L. Hermansson2, A. Larsson3, 1Thermo Fisher Scientific, Phadia AB, Uppsala, Sweden, 2Thermo Fisher Scentific, Phadia AB, Uppsala, Sweden, 3Uppsala University, Department of Medical Science, Uppsala, Sweden

Background

The majority of bowel disorders exhibit overlapping symptoms. The inflammatory bowel diseases (IBD) include Crohn's Disease and ulcerative colitis; 7–20% of all IBD cases are children (Burri and Beglinger, 2012). The irritable bowel syndrome (IBS) is a functional disorder, with prevalence 10–20% (Bellini, 2011). The symptoms of IBD and IBS are often common, making diagnosis difficult in primary care. The gold standard to diagnose IBD is endoscopy that turns negative in most of the cases due to the low prevalence of IBD (Molodecky, 2012), it is expensive, uncomfortable and risky for the patient.

F-Calprotectin is a faecal marker of intestinal inflammation; it is significantly elevated in IBD patients compared to the general population; in IBS patients F-Calprotectin levels are lower than in IBD patients. Therefore, F-Calprotectin can be used as a pre-endoscopic technique to differentiate between IBD and IBS.

Our aim is to evaluate the cost-effectiveness of F-Calprotectin compared to the standard pre-endoscopic tests (combined usage of serologic markers CRP and ESR) to distinguish IBD from IBS at the primary care level in selected European markets (UK, Germany, Austria, Sweden).

Methods

F-Calprotectin and CRP+ESR test accuracy input to the model was evaluated on existing data (Mascialino, 2012). The costs include general practitioner, specialist, diagnostic tests, diet and medications, and were collected from the literature. The outcomes include cost avoidance, costs per corrected IBD/IBS patient diagnosed, and endoscopies reduction.

Results

In all the countries considered, results show that the usage of F-Calprotectin is cost-effective: (a) it results in more corrected IBD diagnoses at a lower price (in both groups in UK it costs at least 100 £ less per patient than CRP+ESR, in Sweden at least 2000 SEK less), (b) it reduces the number of unnecessary endoscopies.

Conclusion

F-Calprotectin is a cost-effective methodology to rule out IBD in the primary care n all the countries considered, and it has a higher accuracy than CRP+ESR. The cost-effectiveness results are amplified when indirect costs (related to caregivers) are included in the calculations.

Burri E, et al, Swiss Medical Weekly (2012), 142: w13557.

Bellini M, et al, World Journal of Gastroenterology (2011), 17 (46): 5089–5096.

Molodecky NA, et al, Gastroenterology (2012), 142: 46–54.

Mascialino B, et al, A, Value in Health (2012), 15: A356.