PATIENT CARE Cost effective monitoring
At UEGW in Barcelona in October 2017 Dr Elsafi and colleagues from the Mercy University Hospital, Cork published a poster entitled “Cost effectiveness of IBDoc as a surrogate marker of mucosal healing in IBD patients post induction of biological agents.” This poster described their study of IBD patients who had recently commenced anti- TNF drug therapy. Traditionally patients starting biologics have a follow up appointment in the clinic after three months and a routine colonoscopy at six months, to assess mucosal healing.
131 patients were provided with the BÜHLMANN IBDoc assay, enabling them to test their own calprotectin levels at home at the three and six months post induction of biological agents. This avoided the need to attend hospital appointments to obtain a calprotectin result. Results from the IBDoc tests were transferred to the gastroenterology team’s database.
At the three month assessments the IBDoc results showed that 40% of the patients had normal calprotectin levels. After six months 75% of the patients showed normal calprotectin levels.
Of the 78 patients that had a raised IBDoc calprotectin at three months, 28% of these had a normal reading after six months. Overall, using the IBDoc calprotectin results as indicators of mucosal healing, a total of 53 clinic visits and 62 colonoscopies were not required because the calprotectin
patients out of hospital, if they are showing low calprotectin levels, will free up limited resources and reduce waiting times for the more active patients.
As more clinics are adopting the use of patient self-testing for calprotectin this may start to become the norm for
The CALEX Valve device enables the patient to collect and extract their faecal sample and apply it to the test cassette with no complex processing. Using the CalApp, the patient’s Smartphone becomes the test reading device giving a quantitative result that is automatically transmitted to the clinic.
results were within normal limits. This represents a significant cost saving plus the benefits of better managed healthcare resources, reducing demand and therefore the waiting times for both clinic visits and colonoscopies.
Although many of the studies with the IBDoc calprotectin home-test have been performed to predict flares or response to treatment in patients with moderate to severe symptoms, there is also the potential to use the technology with patients who are experiencing mild disease or who are in remission.
Using App technology to keep well
managing/monitoring IBD positive patients. Traditional laboratory tests may be reserved for the IBD verses IBS screen, which still accounts for approximately 80% of the workload.
App technology has the ability not only to improve the health of patients, but to save money through rapid optimisation of treatment, enable early interventions through monitoring before conditions get too serious and reduce routine check-up appointments/ procedures, freeing up limited resource in both pathology and the clinic.
References
1. NHS to offer free devices and apps to help people manage illnesses. The Guardian 17th June 2016
2. NICE Dec 2017 Point-of-care and home faecal calprotectin tests for monitoring treatment response in inflammatory bowel disease
3. Elsafi et al 2017 UEGW. Cost effectiveness of IBDoc as a surrogate marker of mucosal healing in IBD patients post induction of biologic agents
4. Raker et al 2017 ECCO Home testing for faecal calprotectin follow-up results from the first UK trial
5. Fitzgerald et al 2017 ECCO An evaluation of patient satisfaction with IBDoc calprotectin home test system.
CSJ
SEPTEMBER 2018
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