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."