Evaluation of the Cost-Utility of the York Faecal Calprotectin Care Pathway

ABSTRACT

Background: Lower gastrointestinal symptoms are common in the general population and it can be difficult to discriminate between inflammatory bowel disease (IBS) and irritable bowel syndrome (IBD) due to overlap of symptoms. The York Fecal Calprotectin Care Pathway (YFCCP) was introduced in 2016 as an alternative to the NICE fecal calprotectin pathway (DG11). This analysis uses the prospective data from the first 1005 patients in the YFCCP. Previous analysis demonstrated the YFCCP may be cost-saving when compared with the DG11 pathway. This analysis examined the short-term health-related quality of life (HRQoL) impact for patients in the YFCCP for IBD and IBS.

Methods: A decision tree model was used to estimate the proportion of people presenting with lower gastrointestinal symptoms that were correctly or falsely diagnosed with IBS and IBD. Time to diagnosis data was estimated and HRQoL data was estimated from published sources. Costs and QALYs were calculated for the YFCCP and each comparator.

Results: The YFCCP was cost-effective at a £20,000 threshold when compared with the current NICE recommended pathways and was cost-saving with a QALY gain (dominant)in four of the five comparators. Conclusions: The YFCCP demonstrated a QALY benefit when compared with all alternative pathways.

KEYWORDS:

• Diagnostic
• Fecal calprotectin
• general practice
• health-related quality of life
• inflammatory bowel disease
• irritable bowel syndrome

Article Highlights

What is already known about this subject?

• Since the publication of the National Institute for Health and Care Excellence (NICE) guidance in 2013, there has been no agreed approach to fecal calprotectin (FC) testing in primary care.

• Using the standard 50 µg/g cut-off, many patients with irritable bowel syndrome (IBS) will have a falsely positive FC

• Previous analysis has shown the YFCCP is potentially cost-saving and uses fewer resources under certain conditions than the NICE guidance pathway for FC testing in primary care

How might it impact on clinical practice in the foreseeable future?

• The YFCCP represents an alternative approach that should be considered for diagnosis of IBD and IBS in primary care on a national level

Declaration of interest

JM (at the time of analysis), HD and HH work for York Health Economics Consortium, a consultancy company, who was commissioned by the Yorkshire & Humber AHSN to undertake the original analysis. There is no further support from any organization for the submitted work and no further financial relationships with any organizations that might have an interest in the submitted work in the previous three years.

Author contribution

HH developed the original YHEC model and conducted the original analysis. JT and VV contributed to the YHEC analysis. HH and JM built the adapted model. JT contributed to the adapted model. HD, HH and JT drafted the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Notes

1. As recommended in NICE clinical guideline for IBS, CG 61, https://www.nice.org.uk/guidance/cg61/chapter/1-Recommendations#pharmacological-therapy.

2. As recommended in NICE clinical guideline for IBS, CG 61, https://www.nice.org.uk/guidance/cg61/chapter/1-Recommendations#pharmacological-therapy.

Additional information

Funding

The YHEC analysis was supported by the Yorkshire & Humber AHSN.