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Effectiveness and Cost-Effectiveness of Measuring Fecal Calprotectin in Diagnosis of Inflammatory Bowel Disease

Effectiveness and Cost-Effectiveness of Measuring Fecal Calprotectin in Diagnosis of Inflammatory Bowel Disease

Clinical Gastroenterology and Hepatology

The level of fecal calprotectin (FC) can predict the onset of inflammatory bowel disease (IBD) with high accuracy and precision. We evaluated the cost-effectiveness of using measurements of FC to identify adults and children who require endoscopic confirmation of IBD. We constructed a decision analytic tree to compare the cost-effectiveness of measuring FC before endoscopy examination with that of direct endoscopic evaluation alone. A second decision analytic tree was constructed to evaluate the cost-effectiveness of FC cut-off levels of 100 g/g vs 50 g/g (typically used to screen for intestinal inflammation). The primary outcome measure was the incremental cost required to avoid 1 false-negative result using FC level to diagnose new-onset IBD. In adults, FC screening saved $417/patient but delayed diagnosis for 2.2/32 patients with IBD, among 100 screened patients. In children, FC screening saved $300/patient but delayed diagnosis for 4.8/61 patients with IBD, among 100 screened patients. 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 FC screening. Sensitivity analyses showed that cost effectiveness of FC screening varied with the sensitivity of the test and the pre-test probability of IBD in adults and children. Pre-test probabilities for IBD of a 75% in adults and a 65% in children made FC screening cost-effective, but cost ineffective if the probabilities were a 85% and a 78% in adults and children, respectively. Compared to the FC cut-off level of 100 g/g, the cut-off level of 50 g/g cost an additional $55 and $43 for adults and children, respectively, but yielded 2.4 and 6.1 additional accurate diagnoses of IBD per 100 screened adults and children. 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 pretest probability is a 75% for adults and a 65% for children. The utility of the test is greater for adults than children. Increasing the FC cut-off level to a 50 g/g increases diagnostic accuracy without substantially increasing total cost.

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Accession: 037041129

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DOI: 10.1016/j.cgh.2013.06.028

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