Popis: |
Introduction Faecal calprotectin (FCP) testing is a useful tool in the diagnostic work-up for differentiating Inflammatory Bowel Disease (IBD) from non-inflammatory bowel diseases. However, despite current support for its use, current guidelines lack clear instruction on cut off levels and diagnostic pathways. Most guidelines have a normal/abnormal cut off of 50micrograms/g. A potential new primary care guideline, proposed by the National Faecal Calprotectin Task and Finish Group, has been proposed but not yet implemented. In brief, the new algorithm states that if FCP is 250 micrograms/g a referral to gastroenterology is indicated. As well as helping to guide clinicians, it should also help to reduce the referral rates to secondary care for unnecessary invasive investigations, albeit with the introduction of repeat tests, potentially at the expense of increased laboratory workload. European studies have shown large financial benefit to FCP testing (Mindemark and Larsson). Locally 41% of referrals with an elevated FCP undergo colonoscopy. Method All FCP tests requested from primary care that are served by a single pathology laboratory in South West London between 01/01/16 and 31/12/16 were collated. The data was then separated into categories according to both the cut-offs for existing guidelines and the potential new guidelines. Costs were calculated (£29 for a faecal calprotectin test and £680 for an adult colonoscopy(Mindemark and Larsson)) under both guidelines. Results 6,962 FCP tests were requested, 1375 were excluded due to an insufficient sample. 5577 were included in the study. Under the current guidelines there were 936 referrals to secondary care, with 384 colonoscopies (£261 k). Under the new proposals there would be 321 initial referrals, a 65.7% reduction. If all of these underwent colonoscopy calculated cost would be £218 k. 279 patients fell into the repeat testing category (costing £8 k). Introducing new guidelines would predict a saving of £43K on colonoscopy at a laboratory expense of £8 k. Conclusions Implementation of the potential new primary care guidelines could result in markedly fewer referrals to secondary, with a small increase in laboratory workload, and could thus reduce the strain for secondary care services. In SW London this could save £35 k, and lead to a reduction in secondary care referrals but lead to an increase in primary care reviews. |