Evaluating the clinical and economic consequences of using video capsule endoscopy to monitor Crohn’s disease

Figures & data

Table 1 Efficacy and safety of monitoring

	SBC^a	Ileocolonoscopy	MRE
Sensitivity^b	93%^Citation32	90%^Citation45	81%^Citation29
	SB 100%^Citation27,Citation29	SB -
Specificity^b	84%^Citation32	100%^Citation45	86%^Citation29
	SB 91%^Citation27,Citation29	SB -
Subsequent hospitalization	–	1.63%^Citation46	0
Bowel obstruction	^c	0.08%^Citation47	0
Gastrointestinal bleeding	–	0.42%^Citation48	0
Infection	–	4%^Citation49	0
Capsule retention	2.0%^Citation18	–	0

Notes: ^aNot all data are specific to SBC, some data come from studies of generic VCE devices. ^bSensitivity and specificity are defined in individual studies but in general reflect accurate diagnosis relative to the gold standard used in the referenced study. ^cCapsule retention can result in bowel obstruction. To account for this in the model 5% of capsule retention events require surgical removal.

Abbreviations: MRE, Magnetic resonance enterography; SB, Small bowel; SBC, Small bowel and colon video capsule endoscopy; VCE, video capsule endoscopy. Together ileocolonoscopy and MRE form what is here considered common monitoring practice (CMP).

Figure 1 Comparison of major surgical outcomes between the model and published literature on Crohn’s disease. Bowel resection after 6 years using CMP (black crosses) is closely aligned to data published by Froslie et al,³⁰ in initial years showing similarity to patients with mucosal healing and in later years transitioning to data for patients with active disease (A). Over 20 years (B), model data for bowel resection when using CMP (black crosses) and SBC (blue circles) is in line with data presented by Bernstein et al.³¹ To 10 years, SBC data most closely resemble that of the most recent clinical data. In both cases, model data are overlaid on figures extracted from the original, referenced publications.

Abbreviations: SBC, Small bowel and colon video capsule endoscopy; CMP, Common monitoring practice.

Figure 2 Cost-effectiveness of SBC by group size. The percentage of groups in which SBC would be considered cost-effective at $50,000 USD per QALY gained is shown on the Y-axis, with the group size in question shown on the X-axis.

Abbreviation: SBC, Small bowel and colon video capsule endoscopy.

Figure 3 Time to event for use of biologic agents and bowel resection. Time to event data are presented for onset of biologic active treatments for Crohn’s disease (A) and surgery for colonic resection (B). In (A), proportion of patients on treatment by year is shown. In (B), the proportion of patients surgery-free is depicted.

Abbreviation: SBC, Small bowel and colon video capsule endoscopy.

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