ABSTRACT

Background: Lower gastrointestinal symptoms are common in the general population and it can be difficult to discriminate between inflammatory bowel disease (IBS) and irritable bowel syndrome (IBD) due to overlap of symptoms. The York Fecal Calprotectin Care Pathway (YFCCP) was introduced in 2016 as an alternative to the NICE fecal calprotectin pathway (DG11). This analysis uses the prospective data from the first 1005 patients in the YFCCP. Previous analysis demonstrated the YFCCP may be cost-saving when compared with the DG11 pathway. This analysis examined the short-term health-related quality of life (HRQoL) impact for patients in the YFCCP for IBD and IBS.

Methods: A decision tree model was used to estimate the proportion of people presenting with lower gastrointestinal symptoms that were correctly or falsely diagnosed with IBS and IBD. Time to diagnosis data was estimated and HRQoL data was estimated from published sources. Costs and QALYs were calculated for the YFCCP and each comparator.

Results: The YFCCP was cost-effective at a £20,000 threshold when compared with the current NICE recommended pathways and was cost-saving with a QALY gain (dominant)in four of the five comparators. Conclusions: The YFCCP demonstrated a QALY benefit when compared with all alternative pathways.

摘要

背景：下消化道症状在普通人群中很常见，由于症状重叠，很难区分炎症性肠病 (IBS) 和肠易激综合征 (IBD)。约克粪便钙卫蛋白护理途径 (YFCCP) 于 2016 年推出，作为 NICE 粪便钙卫蛋白途径 (DG11) 的替代方案。该分析使用来自 YFCCP 的前 1005 名患者的前瞻性数据。先前的分析表明，与 DG11 途径相比，YFCCP 可能会节省成本。该分析检查了 YFCCP 中 IBD 和 IBS 患者的短期健康相关生活质量 (HRQoL) 影响。

方法：决策树模型用于估计出现下消化道症状的人被正确或错误诊断为 IBS 和 IBD 的比例。估计诊断数据的时间，并从已发表的来源估计 HRQoL 数据。计算了 YFCCP 和每个比较器的成本和 QALY。

结果：与当前 NICE 推荐的途径相比，YFCCP 在 20,000 英镑的阈值下具有成本效益，并且在五个比较器中的四个中具有 QALY 增益（主要）节省成本。结论：与所有替代途径相比，YFCCP 证明了 QALY 益处。