A224 COST-EFFECTIVENESS ANALYSIS OF FECAL CALPROTECTIN USED IN PRIMARY CARE IN THE DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE
Bibliographic record
Abstract
Inflammatory bowel diseases (IBD) are chronic conditions with a relapsing and remitting course. The presenting symptoms are heterogeneous and may overlap with other gastrointestinal conditions such as irritable bowel syndrome (IBS), which can lead to delays in diagnosis. Fecal calprotectin (FCP) is a protein excreted from granulocytes and is an accurate marker of intestinal inflammation. When done at the primary care level, it could be a cost-effective method to prioritize and expedite referrals at the specialist level. Assessment of the cost-effectiveness of introducing FCP testing at the primary care level in the diagnosis of IBD. A decision analytic tree with a one- year time horizon was constructed to estimate the cost-effectiveness of FCP test versus standard practice of blood test at primary care level, in adult patients presenting symptoms suggestive of IBS or IBD, from a health system perspective in Canada. Outcomes were incremental cost-effectiveness ratio (ICER) of FCP test versus standard of care, the additional cost to avert one false negative (FN) result by FCP test, and time to diagnosis. The ICER of FCP test was $102,669.32 per quality-adjusted life year (QALY). The ICER was sensitive towards prevalence of IBD, monthly utility decrement of IBD, and cost of FCP test. Probabilistic analysis demonstrated that at a willingness- to- pay threshold of $50,000 per QALY, there was only 3.28% chance of FCP test being cost- effective. It would cost an additional $1,180.57 to avert one FN result with FCP test, as compared to standard of care. The use of FCP test at primary care shortened the time to IBD diagnosis by 19.10 days. The result of the analysis suggested that FCP test was not cost- effective in the diagnosis of adult IBD in Canada. However, this analysis was not without limitations. The limitations were mainly due to the lack of key data such as prevalence, as well as cost and utility decrement due to complications associated with endoscopy. Further threshold analysis will identify at which prevalence level, e.g., FCP test can be cost effective. Janssen, Future Leaders in IBD Grant
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.006 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".