Barbara Mascialino
Thermo Fisher Scientific ImmunoDiagnostics | Swedan
Title: The pre-endoscopic screening test EliA Calprotectin 2 is a cost-saving technique compared to serological markers and colonoscopy: The Japanese perspective
Biography
Biography: Barbara Mascialino
Abstract
The majority of bowel disorders exhibit overlapping symptoms, making diagnosis difficult in primary care (PC). Inflammatory bowel diseases (IBDs) are characterized by chronic inflammation of the gastrointestinal tract; irritable bowel syndrome (IBS) is a functional disorder, with prevalence 10-20%. Endoscopy is the gold standard for detecting and quantifying IBDs, but due to its low prevalence (in Japan: 152x105 persons), it turns negative in most cases, it is expensive, uncomfortable and risky for the patient. F-Calprotectin is a fecal marker of intestine inflammation that can be used as a pre-endoscopic technique to rule out IBDs.
EliA Calprotectin 2 is expected to be launched into the Japanese market in 2017. The present study aims at evaluating the cost-effectiveness of a) EliA Calprotectin 2 test compared to the b) usage of serologic markers CRP and ESR, c) combined usage of these tests, and d) gold standard to distinguish IBD from IBS in Japan.
Methodology: A 18-weeks Markov model was developed for each diagnostic strategy, simulating 1000 patients presenting to PC with unspecific gastrointestinal symptoms. Outcomes include cost savings, cost per corrected IBD diagnosed, and colonoscopies reduction (including their complications). Uncertainty was addressed with sensitivity analysis.
Findings: Table 1 shows that EliA Calprotectin 2 is cost-effective compared to CRP+ESR, and to colonoscopy; it:
1) Results in more corrected IBD diagnoses at a lower price;
2) Reduces the number of unnecessary endoscopies, increasing the number of correctly diagnosed IBD (N=63) and IBS (N=26) patients.
Conclusion: Results show that the usage of EliA Calprotectin 2 as pre-endoscopic diagnostic tool is associated with less colonoscopies, and important cost savings ascribable to reduced resource utilization. F-Calprotectin is a dominant strategy in relation to the comparators; it should be recommended for reimbursement in Japan, and can be considered as good value for money for the health insurance system.
|
|
EliA Calprotectin 2 |
CRP+ESR |
Colonoscopy |
|
Total costs (YEN) |
17 913 568 |
22 232 221 |
33 102 599 |
|
Average cost/patient (YEN) |
17 914 |
22 232 |
33 103 |
|
N colonoscopies avoided |
736 |
722 |
0 |
|
Colonoscopy- costs avoided (YEN) |
22 271 517 |
21 863 202 |
0 |
|
N correctly diagnosed IBS |
683 |
657 |
- |
|
N correctly diagnosed IBD |
98 |
35 |
- |
|
Colonoscopy -complications costs (YEN) |
45 955 |
50 835 |
141 504 |
Recent Publications
- Lin W-C et al. (2015). Fecal calprotectin correlated with endoscopic remission for Asian inflammatory bowel disease patients. World J Gastroenterol; Dec; 21(48):13566-73. doi: 10.3748/wjg.v21.i48.13566.
- Bellini M et al. (2011). Evaluation of latent links between irritable bowel syndrome and sleep quality. World J Gastroenterol Dec 14;17(46):5089-96. doi: 10.3748/wjg.v17.i46.5089.
- Ng W-K et al. (2016). Changing epidemiological trends of inflammatory bowel disease in Asia. Intest Res 14(2): 111-119. doi: 10.5217/ir.2016.14.2.111. Epub 2016 Apr 27.
- Tibble JA et al. (2002). Use of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal disease. Gastroenterology Aug;123(2):450-60.
- Yang Z et al. (2014). Effectiveness and cost-effectiveness of measuring fecal calprotectin in diagnosis of inflammatory bowel disease in adults and children. Clin Gastroenterol Hepatol.; Feb;12(2):253-62.e2. doi: 10.1016/j.cgh.2013.06.028. Epub 2013 Jul 21.
- Ranasinghe I et al (2015). Differences in colonoscopy quality among facilities: development of a post-colonoscopy risk-standardized rate of unplanned hospital visits. Gatroenterology. Jan;150(1):103-13. doi: 10.1053/j.gastro.2015.09.009. Epub 2015 Sep 25.