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P738 Assessing aCCess to investigations in IBD (ACCID) – results from an international inflammatory bowel disease survey

Ding N.S.*1,2,3, Yazdanian B.4, Bettenworth D.5, Cleynen I.6, Yassin N.A.2, Armuzzi A.7, Ferrante M.8, Zagorowicz E.S.9, Mansfield J.10, Gisbert J.11, Raine T.4

1St Vincent's Hospital, Inflammatory Bowel Disease, Melbourne, Australia 2St Mark's Hospital, Inflammatory Bowel Disease Unit, London, United Kingdom 3Imperial College London, Department of Surgery and Cancer, London, United Kingdom 4Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom 5University Hospital Münster, Department of Medicine B, Münster, Germany 6KU Leuven, Leuven, Belgium 7Complesso Integrato Columbus Gastroenterology Unit Via Moscati 31, 167 Rome, Italy, Rome, Italy 8UZ Leuven Department of Gastroenterology Herestraat 49, 3000, Leuven, Belgium 9The Maria Sklodowska Curie Memorial Cancer Centre and Institute of Oncology Department of Gastroenterology ul. W.K. Roentgena 5, 02–781, Warsaw, Poland 10Royal Victoria Infirmary Department of Gastroenterology Queen Victoria Road, Newcastle Upon Tyne, United Kingdom 11Hospital Universitario de La Princesa Department of Gastroenterology Calle de Diego Leon, 62, Madrid, Spain


In recent years, several new investigations to aid diagnosis and monitoring of IBD have become available. These include faecal calprotectin (FC), widely regarded as a surrogate for intestinal inflammatory activity and therapeutic drug monitoring (TDM) for thiopurine metabolites and anti-TNF therapy. However, uptake and access has not been uniform. We aimed to assess barriers to access of these investigations.


Questionnaires were distributed to delegates at the 11th Congress of ECCO. Analysis of responses was performed using R statistical software including binomial linear regression analysis for potential barriers to access, including health economic data extracted from the WHO Global Health Expenditure database.


195 valid responses were obtained from participants from 38 countries, including paediatricians (14%), adult gastroneterologists (42%) and gastroenterologists-in-training (35%). 135 (39%) of respondents were practicing in an academic hospital. High volume IBD work (≥1IBD patient/day) was reported by 61.8%.

FC was available to 92.3%, most using at least weekly (80.3%). Access to anti-TNF TDM was less widespread (78.9%; p=0.0002) and less heavily used (45.8% using at least weekly; p<0.0001). Access to TDM for infliximab was better than for adalimumab (p=0.0004). Thiopurine TDM was least widely available (67.7%; p=0.0001 vs FC, p=0.02 vs anti-TNF TDM) but used at an intermediate level where available (56.5% reporting at least weekly usage; p<0.01 vs both other groups). There was heterogeneity and lack of consensus when asked to identify situations where they might use each investigation.

Access to all 3 investigations within Europe showed a significant East (E)–West (W) and North (N)–South (S) divide. For FC we found W vs E: 95.1% vs 82.0% (p=0.04) and N vs S: 97.3% vs 80.4% (p=0.001), with similar statistically significant comparisons for both other tests.

Multivariable analysis showed that the strongest independent predictors of access to all 3 tests was health-care spending per capita (p=0.005 for FC; p<0.0001 for both TDM). Working in an academic centre was an independent predictor of access to TDM (p=0.03 for anti-TNF; p=0.02 for thiopurine). Respondents were more likely to cite cost as a barrier to accessing anti-TNF TDM (30.8%) or FC (24.6%) than thiopurine TDM (12.3%; p<0.0001 and 0.003).


Investigations for the purpose of personalizing therapy have revolutionized IBD care. FC, anti-TNF and thiopurine TDM have been incorporated into routine practice in much of Europe. Increased healthcare spending in IBD care with a focus on Eastern and Southern European countries may improve access to these integral investigations.


[1] Burisch et al. Epi-COM group, (2014), East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort, GUT, 588–97