Department of Gastroenterology, Eastern Health, Monash University, Melbourne, Victoria, Australia.
Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
Intern Med J. 2019 Jan;49(1):94-100. doi: 10.1111/imj.14027.
Faecal calprotectin (FC) is an accurate biomarker of disease activity in inflammatory bowel disease (IBD), yet the cost/resource implications of incorporating FC into 'real-world' practice remain uncertain.
To evaluate the utility of FC in clinical decision-making and on healthcare costs in IBD.
Retrospective data, including colonoscopy/other investigations, medication, admission and surgical data, were collected from hospital records and compared between two groups: pre-FC historical cohort (2005-2009) where colonoscopy was used to assess IBD activity versus the cohort where FC was used first instead (2010-2014). Post-test costs were also compared.
A total of 357 FC tests (246 patients, 2010-2014) and 450 colonoscopies (268 patients, 2005-2009) were performed. On subsequent review, both FC and colonoscopy (in their respective cohorts) were associated with changes in management in 50.7 versus 56.2% (P = 0.14), respectively, with similar proportions of subsequent IBD-related investigations within 6 months (21.8 vs 21.9%, P = 1.0). Prior to FC availability (2005-2009), a colonoscopy for disease reassessment cost AU$606 578 (cost per patient-year $1887.34) versus AU$282 048 (cost per patient-year $968.60) when FC ± colonoscopy was used (2010-2014). Within the FC cohort, 73.6% did not proceed to colonoscopy within 6 months post-FC, and 60.6% had not undergone colonoscopy post-FC by the end of follow up (median 1.8 years (0.1, 4.6) post-FC). Those with FC ≥ 250 were scoped earlier than those with FC < 100 μg/mL (median 0.49 vs 1.0 years, P = 0.03).
Introduction of FC into routine IBD care aided changes in clinical management in a similar proportion, yet at potentially half the total cost, compared to a historical colonoscopy-only cohort at the same centre.
粪便钙卫蛋白（FC）是炎症性肠病（IBD）疾病活动的准确生物标志物，但将 FC 纳入“真实世界”实践的成本/资源影响仍不确定。
评估 FC 在 IBD 临床决策中的效用及其对医疗保健成本的影响。
从医院记录中收集了包括结肠镜检查/其他检查、药物、住院和手术数据在内的回顾性数据，并将其比较了两组数据：一组是 FC 前历史队列（2005-2009 年），其中结肠镜检查用于评估 IBD 活动；另一组是 FC 首次用于评估的队列（2010-2014 年）。还比较了后续检测的成本。
共进行了 357 次 FC 检测（246 名患者，2010-2014 年）和 450 次结肠镜检查（268 名患者，2005-2009 年）。随后的复查结果显示，FC 和结肠镜检查（在各自的队列中）均与 50.7%和 56.2%（P=0.14）的管理变化相关，在 6 个月内进行后续 IBD 相关检查的比例相似（21.8%和 21.9%，P=1.0）。在 FC 可用之前（2005-2009 年），用于疾病再评估的结肠镜检查费用为 606578 澳元（每名患者每年 1887.34 澳元），而当使用 FC±结肠镜检查时，费用为 282048 澳元（每名患者每年 968.60 澳元）（2010-2014 年）。在 FC 队列中，73.6%的患者在 FC 检测后 6 个月内未进行结肠镜检查，60.6%的患者在 FC 检测后 1.8 年（FC 检测后 0.1-4.6 年）未进行结肠镜检查。FC≥250 的患者比 FC<100μg/mL 的患者更早进行内镜检查（中位时间分别为 0.49 年和 1.0 年，P=0.03）。
在同一中心的历史结肠镜检查仅队列中，与 FC 引入 IBD 常规护理相比，FC 辅助临床管理的改变比例相似，但总成本可能减半。
