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 26 September 2016

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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.

News image

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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