PGI32 EVALUATION OF THE COST-UTILITY OF THE YORK FAECAL CALPROTECTIN CARE PATHWAY

Abstract

A previous health economics analysis evaluating the cost-effectiveness of the York Faecal Calprotectin Care Pathway (YFCCP) indicated that YFCCP is cost saving and of clinical benefit when compared with both published data for erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) testing, and with FC testing using a standard <50ug/g cut-off. However, the results indicated a trade-off when compared with published data from NICE guidance for FC testing (DG11), which correctly diagnosed more patients with irritable bowel syndrome (IBS). The current study has added health-related quality of life (HRQoL) data to the original model to measure the cost-utility of the YFCCP using costs and quality adjusted life years (QALYs), whereas previous analysis was used to demonstrate avoided costs from unnecessary resource use. A decision tree model which estimates accurate diagnosis of IBS and inflammatory bowel disease (IBD) for different diagnostic tests was updated to include HRQoL data. The analysis included five comparators. Costs were identified from publicly available sources and were reflective of the NHS. HRQoL for IBS and IBD was sourced from published NICE guidance documents. Diagnostic accuracy of the intervention and comparators were identified from published sources and clinical advice. The analysis had a time horizon of one year. Uncertainty was explored using deterministic sensitivity analysis. YFCCP is dominant (cost-saving with a QALY gain) when compared with four of the five comparators using published efficacy data of ESR + CRP and published data for the standard FC testing. When comparing with the fifth comparator of the NICE published efficacy of standard FC testing (Waugh et al) the YFCCP returned incremental costs of £14,000 and incremental QALYS of 1.62 QALYs per 1000 patients, giving an ICER of approximately £9,000/QALY. The updated model shows the YFCCP pathway is cost-effective against all comparators at a £20,000 threshold.