A158 Cost-Effectiveness of Fecal Calprotectin as a Diagnostic or Monitoring Tool for Ibd: A Single Center Experience

Abstract

Background: Fecal calprotectin (FC) is a protein that is produced by neutrophils and monocytes. It can be detected in tissues, body fluids and stool which makes it valuable marker for neutrophil activity. FC concentrations increase in intestinal inflammation which makes it a valuable tool to distinguish inflammatory from non-inflammatory gastrointestinal conditions. We conducted a retrospective quality assurance audit on the use and cost-effectiveness of fecal Calprotectin assay at the Outpatient Gastroenterology Clinic at the Queen Elizabeth II Health Sciences Center in Halifax, NS. Aims: To assess our use of Feacal Caloprotectin and the cost-effectiveness of it in our practice Methods: Patients being followed through the gastroenterology clinic at the QE II Health Sciences Center who underwent FC testing were identified through lab services at the NSHA central zone. Inclusion criteria included any adult patient being followed through the GI ambulatory clinic at the QE II Health Sciences Center (HSC). A retrospective chart review was conducted for any FC testing performed between September 28, 2017 and March 29, 2017. Clinical visits before and after FC testing were reviewed for indication and to determine the clinical impact of FC testing. We considered FC testing to have had a "positive clinical impact" if it lead to dose escalation or change of medication (IBD management) or aided in endoscopic decision making. FC testing was considered to be cost-effective if supplanted endoscopic investigation for purposes of monitoring or screening patients. Results: One hundred and five FC tests were ordered over a period of 6 months (28th September 2017 to 29 March 2017). Eighty-one FC tests had clinical information which allowed for evaluation of test indications and outcomes. Seventy percent of the patients were female. FC testing was ordered as a screening test for bowel inflammation (21%) or as an IBD disease monitoring tool (77%). The most common clinical symptoms prompting FC testing in IBD patients were diarrhea and abdominal pain (53% and 32%, respectively). The test aided in clinical decision making in 50 patients (61.7%). In some cases, FC results didn't change the clinical decision making process (23%), were not followed-up after the test (13%), or the indication wasn't clear (1%). In 28 patients, the decision to perform endoscopic investigation was prompted by the FC results. Colonoscopy was averted in almost 40 percent of the patients as a result of normal FC concentrations. Conclusions: FC was demonstrated to have significant clinical impact when used to diagnose or monitor patients with IBD. The results of this study suggest that FC-enhanced diagnosis and monitoring may be more cost-effective than non-FC enhanced clinical decision making. Larger, long-term studies that consider the impact on health economics are needed.