The Medical Services Advisory Committee (MSAC) has approved the MBS listing of faecal calprotectin (FP) testing for the differential diagnosis of IBD from IBS in adults and IBD from non-IBD in children.
The long-awaited decision is no doubt welcomed by IBD clinicians but tempered by the fact that FC testing will not yet be available for monitoring inflammatory disease.
GESA IBD faculty chair Associate Professor Jake Begun told the limbic that having a very accurate and non-invasive test for gut pathology on the MBS was a major win for GPs, specialists and patients with GI symptoms.
“This will result in patients getting upfront treatment for functional gut disease from their GP more rapidly, and result in less referrals to gastro specialists for functional disease, and hopefully less colonoscopies performed in young people who do not have organic disease,” he said.
The Public Summary Document of the MSAC decision said FC testing “…had acceptable diagnostic performance (sensitivity and specificity), evidence for comparative effectiveness and clinical utility, while being safer and significantly cheaper than endoscopy/biopsy with specialist referral.”
However it said there was some uncertainty about whether publicly funded FC testing would actually reduce the numbers of specialist referrals and unnecessary colonoscopies.
“MSAC therefore recommended that the Department monitor the utilisation and outcomes of FC testing, in particular the impact on the utilisation of colonoscopies.”
MSAC also noted that a GP education program would be important around the benefits and limitations of FC testing including awareness of alarm symptoms that may invalidate the test or make it inappropriate.
Clinical alarms included unexplained weight loss (>3 kg or 5% bodyweight), iron deficiency ± anaemia, melaena, overt rectal bleeding, abdominal pain or diarrhoea disturbing sleep, faecal incontinence, a family history of colon cancer, IBD or coeliac disease in symptomatic patients.
The target population is “patients aged ≤ 50 years with gastrointestinal symptoms suggestive of inflammatory or functional bowel disease of more than six weeks’ duration who are presenting to a medical practitioner; where infectious causes have been excluded and the likelihood of malignancy has been assessed as low, and where no clinical alarms are present.”
“The FC test is proposed to be used as a “rule-out” test for eligible patients (whether IBD or organic gastrointestinal disorders [OGID] can be ruled out or not), to determine whether specialist referral and further investigations are necessary. It is proposed to be used in primary care, with a repeat test to be ordered by the specialist if the initial FC test result is indeterminate (FC between 50 µg/g and 100 µg/g).”
As previously reported in the limbic, Australian research suggests FC testing can substantially reduce the costs of IBD care.