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Fecal Calprotectin Is Cost-Effective for IBD Screening

Summary and Comment |
February 28, 2014

Fecal Calprotectin Is Cost-Effective for IBD Screening

  1. Douglas K. Rex, MD

The lower cost and invasiveness, as compared with direct endoscopic evaluation, was deemed worth the low rate of delayed diagnoses.

  1. Douglas K. Rex, MD

Calprotectin is a protein shed in the stool of patients with an inflamed bowel. Fecal calprotectin levels have been shown to correlate with healing in inflammatory bowel disease (IBD), to predict relapse, and to differentiate patients with low and high risk for IBD before diagnosis.

In the current study, investigators constructed a decision analytic tree to compare the cost-effectiveness of measuring fecal calprotectin prior to initial diagnosis of IBD with direct endoscopic evaluation alone.

Screening for fecal calprotectin in adults saved $417 per patient but delayed the diagnosis of IBD for 2 of 32 patients with IBD among 100 screened patients. In children, fecal calprotectin screening saved $300 per patient but delayed the diagnosis for 5 of 61 patients with IBD among 100 screened patients. Direct endoscopy would cost an additional $18,955 in adults and $6250 in children to avoid one false-negative result from calprotectin screening. Fecal calprotectin screening was cost-effective when the pretest probability of IBD was ≤75% in adults and ≤65% in children and ineffective with high pretest probabilities of IBD (≥85% and ≥78% in adults and children, respectively). In sensitivity analysis, a calprotectin cutoff value of 50 µg/g was more sensitive and cost-effective than a cutoff of 100 µg/g.

Comment

Fecal calprotectin is increasingly recognized as a useful tool to guide diagnostic testing for inflammatory bowel disease and to guide therapy in patients with established IBD. Patients with symptoms strongly suggestive of IBD should directly undergo colonoscopy and ileoscopy, but other patients could undergo fecal calprotectin screening, with results guiding the need for endoscopy.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Exact Sciences; Ferring Pharmaceuticals; Given Imaging; Olympus Speaker’s bureau Boston Scientific; Braintree; Ferring Pharmaceuticals Grant / research support Battelle; Braintree; Northwestern University; Olympus America Editorial boards Annals of Gastroenterology and Hepatology; Comparative Effectiveness Research; Expert Review of Gastroenterology and Hepatology; Gastroenterology; Gastroenterology and Hepatology News; Gastroenterology Report; Gastroenterology Research and Practice; Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; World Journal of Gastroenterology; World Journal of Gastrointestinal Oncology; World Journal of Gastrointestinal Pathophysiology; World Journal of Gastrointestinal Pharmacology and Therapeutics

Citation(s):

Reader Comments (2)

CARLITO SABANDAL Physician, Emergency Medicine, IU BEDFORD HOSPITAL BEDFORD INDIANS

this probably a good screening tool , especially in my practice location of fewer and difficult GI access .

MARTIN CHRISTIAN Physician, Gastroenterology, Dublin Gastroenterology Associates

Good evaluation

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