EPACT II: Project and Methods

Abstract

Building on the first European Panel on the Appropriateness of Crohn’s Disease Treatment (EPACT I) which was held in Lausanne at the beginning of March 2004, a new panel will be convened in Switzerland (EPACT II, November to December 2007) to update this work. A combined evidence- and panel-based method (RAND) will be applied to assess the appropriateness of therapy for Crohn’s disease (CD). In preparation for the meeting of experts, reviews of evidence-based literature were prepared for major clinical presentations of CD. During the meeting, an international multidis- ciplinary panel that includes gastroenterologists, surgeons and general practitioners weigh the strength of evidence and apply their clinical experience when assessing the appropriateness of therapy for 569 specific indications (clinical scenarios). This chapter describes in detail the process of updating the literature review and the systematic approach of the RAND Appropriateness Method used during the expert panel meeting.

Appropriateness of therapy for fistulizing Crohn’s disease: findings from a national inflammatory bowel disease cohort

“…The EPACT II appropriateness criteria were established for nine broad clinical situations in CD (Table 1): active luminal CD, steroid-dependent or -refractory disease, fistulizing CD, fibro-stenotic CD, upper gastrointestinal CD or extraintestinal manifestations of CD, maintenance of a medically induced or surgically induced remission of CD. 12 Definitions were developed to classify typical patients to be included in each of these clinical situations. The cohort study questionnaires were developed to facilitate inclusion of cases in corresponding clinical situations, by collecting data on variables linked to V V. .…”