PERSPECTIVE 2019 2 “The development of this algorithm offers significant benefits to the patient’s experience along with savings across the health economy. Its adoption by clinical colleagues is welcomed.“ 2 A recent publication from BIVDA and Innovate UK1 identifies three simple tests that could save the NHS £6.9 Billion over a 5 year period if implemented more widely. Faecal calprotectin is one of the tests heralded and it alone is estimated to offer savings of £65 million to the NHS. This could be achieved if calprotectin testing was more widely available to assist in the diagnosis of Inflammatory Bowel Disease (IBD). Although calprotectin is now well established and routinely in use in many hospitals, it is often restricted as a secondary care test. However, if calprotectin was made available more extensively as a primary care test then significant savings could be achieved in outpatient and colonoscopy resource. The challenge is that uncontrolled access to faecal calprotectin testing could result in an increase in cost and greater demands on limited resources (<50µg/g is widely accepted as a negative result, but this doesn’t mean that >50µg/g is positive). In order to address these issues a new pathway for the use of faecal calprotectin testing in primary care is being rolled out across England through the national Academic Health Science Network (AHSN). See Figure 1. The pathway is designed to provide GPs with a risk assessment of a patient’s likely condition based on the results of the faecal calprotectin test. This helps to provide greater confidence in decisions to refer patients to secondary care. The new pathway will help assist in cases where there is uncertainty between the diagnosis of Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). An NHS England Task and Finish group has been formed to create a consensus report on optimising faecal calprotectin testing using this new pathway. The paper is available through the primary care commissioning website2. It has been endorsed by NICE, Crohn’s and Colitis UK and the British Society of Gastroenterologists. Health Economic studies demonstrate considerable financial benefits for primary care, capacity benefits for secondary care and most importantly, better patient experience, through faster diagnosis. Highly significant is the reduction in the number of patients who need to undergo risky , uncomfortable and costly colonoscopies. In the roll-out of the York Faecal Calprotectin Care Pathway (on which the above algorithm is based), compliance was 85% and so the actual (rather than optimal) saving amounted to between £60,000 and nearly £100,000 per 1000 patients. These savings were achieved by correctly supporting the diagnosis of IBS within primary care, avoiding 100–150 colonoscopies and 140–190 gastroenterology outpatient appointments. The AHSN Network is actively engaged in supporting the roll out of this improved pathway across the country after work in Yorkshire and Humber demonstrated significant benefits to the health economy in the region. If you would like to get involved in delivery of the pathway across your area, or want any further information please contact your local AHSN or email Victoria Hilton at victoria.hilton@yhahsn.com A New Pathway for Faecal Calprotectin Testing in Primary Care Improving Patient Care and Access, Saving the NHS £65M References 1. BIVDA and Innovate UK: Three simple tests could save the NHS at least £6.9 billion. www.bivda.org.uk/3_simple_tests.pdf 2018 2. www.pcc-cic.org.uk/article/updatedguidance-help-gps-easily-diagnose-seriousbowel-conditions This issue of Perspective brings together real life case studies from nurses, clinicians and a patient, who discuss developments and changing opinions in diagnostics for digestive diseases. From improved patient well being, efficiences in clinics and potential savings in money and resources from the reduction in colonoscopy requirements, advancing technologies in calprotectin and faecal occult blood testing have a lot to offer. Alpha Laboratories has worked in partnership with clinics and laboratories over many years to champion calprotectin testing for differentiation between IBS and IBD. Our extensive range of standardised assays from BÜHLMANN provides solutions for improved patient care and management in both screening and monitoring applications. At the forefront of faecal testing, we have been involved with the National Bowel Screening Programmes since 1998; originally supplying the guaiac-based test and now the quantitative faecal immunochemical test (FIT) in Scotland and Wales. Close relationships with key opinion leaders and external quality assurance schemes ensure the company is always at the leading edge of diagnostics, and continues to be subject matter experts in the implementation of FIT for symptomatic and screening programmes. for reducing colonoscopy referrals.
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