Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, Canada.
BMJ Open. 2019 Apr 14;9(4):e027043. doi: 10.1136/bmjopen-2018-027043.
Inflammatory bowel disease (IBD) is a chronic, autoimmune, gastrointestinal disorder. Canada has one of the highest prevalence and incidence rates of IBD in the world. Diagnosis is challenging due to the similarity of symptoms to functional gastrointestinal disorders. Faecalcalprotectin (FC) is a biomarker for active mucosal inflammation and has proven effective in the diagnosis of IBD. Our study objective was to assess the cost-effectiveness of adding an FC test compared with standard practice (blood test) in primary care among adult patients presenting with gastrointestinal symptoms.
We constructed a decision analytic tree with a 1-year time horizon. The cut-off level of 100 µg/g was used for FC testing. Probabilistic analyses were conducted for the base case and all scenarios.
Canadian health sector perspective.
A hypothetical cohort of adult patients presenting with gastrointestinal symptoms in the primary care setting.
FC test compared with blood test.
Costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER) of FC test expressed as cost per QALY gained compared with blood test and time to IBD diagnosis.
FC testing is expected to cost more ($C295.1 vs $C273.9) than standard practice but yield little higher QALY (0.751vs0.750). The ICER of FC test was $C20 323 per QALY. Probabilistic analysis demonstrated that at a willingness-to-pay threshold of $C50 000 per QALY, there was 81.3% probability of FC test being cost-effective. The use of FC test in primary care reduced the time to IBD diagnosis by 40.0 days (95% CI 16.3 to 65.3 days), compared with blood testing alone.
Based on this analysis of short-term outcomes, screening adult patients in primary care using FC test at a cut-off level of 100 µg/g is expected to be cost-effective in Canada.
炎症性肠病（IBD）是一种慢性、自身免疫性的胃肠道疾病。加拿大是世界上 IBD 发病率和患病率最高的国家之一。由于其症状与功能性胃肠道疾病相似，因此诊断具有挑战性。粪便钙卫蛋白（FC）是黏膜炎症活动的生物标志物，已被证明可有效诊断 IBD。我们的研究目的是评估在出现胃肠道症状的成年患者的初级保健中，与标准检测（血液检测）相比，增加 FC 检测的成本效益。
我们构建了一个具有 1 年时间范围的决策分析树。FC 检测的截断值为 100μg/g。对基本情况和所有情况进行了概率分析。
加拿大卫生部门视角。
初级保健环境中出现胃肠道症状的成年患者的假设队列。
FC 检测与血液检测比较。
成本、质量调整生命年（QALY）、FC 检测的增量成本效益比（ICER），表示为每获得一个 QALY 相对于血液检测的成本，以及 IBD 诊断时间。
FC 检测的预期成本（$C295.1 比 $C273.9）高于标准检测，但获得的 QALY 略高（0.751 比 0.750）。FC 检测的 ICER 为每 QALY$C20323。概率分析表明，在支付意愿阈值为每 QALY$C50000 的情况下，FC 检测具有成本效益的概率为 81.3%。与单独使用血液检测相比，在初级保健中使用 FC 检测可将 IBD 诊断时间缩短 40.0 天（95%CI 16.3 至 65.3 天）。
基于对短期结果的分析，在加拿大，使用 FC 检测（截断值为 100μg/g）对成年患者进行初级保健筛查预计是具有成本效益的。
