Faecal calprotectin reduces cost but not quality of IBD care

The incorporation of faecal calprotectin testing in the assessment of IBD activity can half the cost of disease reassessment in a specialist IBD clinic, according to an Australian study.

The findings provide more compelling support for efforts to secure an MBS item number for the test.

The Victorian study compared patients treated at a clinic between 2009 and 2014 when faecal calprotectin had become available to an historical cohort of patients from the same clinic between 2005 and 2009 when only colonoscopy was available.

It found faecal calprotectin assessment was associated with a similar proportion of changes in management at subsequent clinical review to those associated with colonoscopy examination. There was also a similar proportion of subsequent IBD-related investigations within six months.

The majority of patients assessed via faecal calprotectin did not proceed to colonoscopy at all within the follow-up period. Those that did were obviously triaged on the basis of their faecal calprotectin, with higher titres having a shorter median time to colonoscopy compared to those with low titres.

During the earlier five-year period, there were 450 colonoscopies performed for disease assessment at a total cost of $606,577 or $1,887 per patient-year.

However the total cost was just $282,048 or $968 per patient-year – a 51% reduction in costs – when using faecal calprotectin during the more recent time period.

“Furthermore, the cost differential would only be greater if indirect costs were also included, given the relative convenience of FC for patients versus the loss of productivity and absenteeism caused by bowel preparation, sedation and attendance at a healthcare facility as are typically required for colonoscopy – though this is beyond the scope of the present study,” the study said.

The researchers from Eastern Health and Monash University said the study demonstrated that faecal calprotectin could substantially reduce costs for payers and inconvenience for patients without comprising the quality of care.

“With the growing imperative of cost containment and resource utilisation, faecal calprotectin has been shown to have gained the trust and confidence of clinicians within a short timeframe, become a useful tool in triaging colonoscopy, and enhanced treatment decision making.”

Dr Daniel van Langenberg, head of IBD at Eastern Health, said the study showed that adding a new test doesn’t always cost payers more.

“It is actually going to cost less overall if it’s used in the right way. There have been a lot of studies showing how sensitive and specific faecal calprotectin is in detecting inflammation in the bowel and also monitoring response to treatment in IBD.”

“It’s important to have shown now that it does potentially reduce costs in the real world scenario in Australia; hopefully important ammunition to sway Medicare and the payers about the utility of faecal calprotectin.”

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