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News

Screening fecal calprotectin in diagnosis of IBD is effective

The latest issue of the Clinical Gastroenterology & Hepatology evaluates the effectiveness and cost-effectiveness of measuring fecal calprotectin in diagnosis of IBD in adults and children.

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The level of fecal calprotectin can predict the onset of inflammatory bowel disease (IBD) with high accuracy and precision.

Dr Park and colleagues from California, USA evaluated the cost-effectiveness of using measurements of fecal calprotectin to identify adults and children who require endoscopic confirmation of IBD.

The researchers constructed a decision analytic tree to compare the cost-effectiveness of measuring fecal calprotectin before endoscopy examination with that of direct endoscopic evaluation alone.

A second decision analytic tree was constructed to evaluate the cost-effectiveness of fecal calprotectin cutoff levels of 100 μg/g vs 50 μg/g.

Fecal calprotectin screening saved $417 per patient
Clinical Gastroenterology & Hepatology

The team's primary outcome measure was the incremental cost required to avoid 1 false-negative result by using fecal calprotectin level to diagnose new-onset IBD.

In adults, fecal calprotectin screening saved $417 per patient but delayed diagnosis for 2 out of 32 patients with IBD among 100 screened patients.

In children, fecal calprotectin screening saved $300 per patient but delayed diagnosis for 5 out of 61 patients with IBD among 100 screened patients.

The team observed that if endoscopic biopsy analysis remained the standard for diagnosis, direct endoscopic evaluation would cost an additional $18,955 in adults, and $6250 in children to avoid 1 false-negative result from fecal calprotectin screening.
 
Sensitivity analyses showed that cost-effectiveness of fecal calprotectin screening varied with the sensitivity of the test, and the pre-test probability of IBD in adults and children.

The researchers found that pre-test probabilities for IBD of 75% or less in adults, and 65% or less in children made fecal calprotectin screening cost-effective.

However, it was cost-ineffective if the probabilities were 85% or more and 78% or more in adults and children, respectively.

Compared with the fecal calprotectin cutoff level of 100 μg/g, the cutoff level of 50 μg/g cost an additional $55 and $43 for adults and children, respectively.

However, the team noted that it yielded 2 and 6 additional accurate diagnoses of IBD per 100 screened adults and children, respectively.

Dr Park's team concludes, "Screening adults and children to measure fecal levels of calprotectin is effective and cost-effective in identifying those with IBD on a per-case basis when the pre-test probability is ≤75% for adults and ≤65% for children."

"The utility of the test is greater for adults than children."

"Increasing the fecal calprotectin cutoff level to ≥50 μg/g increases diagnostic accuracy without substantially increasing total cost."

Clin Gastroenterol Hepatol 2014: 12(2):  253-262.e2
24 January 2014

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