A Novel Ibs Diagnostic Blood Panel Can Enhance A Positive Diagnostic Strategy Versus A Strategy Of Exclusion For Patients With Diarrhea Predominant Irritable Bowel Syndrome (Ibs-D): Cost Implications For Denmark


      Current guidelines recommend a positive strategy based on symptom criteria without alarm features vs diagnostic exclusion which includes several laboratory and diagnostics procedures to exclude other organic conditions. A novel IBS diagnostic blood panel tests for the presence of two biomarkers associated with IBS-D which can complement the positive strategy. This analysis assesses the cost impact to the Danish healthcare system by introducing this test into the diagnostic pathway.


      A budget impact model was based on a cost-minimization decision model developed to compare the costs associated with two possible diagnostic pathways: (1) diagnostic pathway with a novel IBS diagnostic blood panel and (2) exclusionary diagnostic pathway and applied to the Danish population 18-65yrs old. Model structure was based on current literature and guidance from IBS expert clinicians. Direct medical expenses for laboratory tests, diagnostic procedures and visit costs were included in Danish Krone and weighted by utilization rates estimated by a practicing gastroenterologist in Denmark. Indirect cost only included time off work based on a published Danish study.


      Sigmoidoscopy, colonoscopy and SBFT were the most common diagnostic procedures reported with estimated utilization rates of 35%, 35% and 15%, respectively. Corresponding charges were kr4819, kr4819 and kr1861, respectively. Estimated total base case charges for the IBS diagnostic blood panel pathway (assumes 75% of test positive patients receive IBS-D treatment) vs the exclusionary pathway were kr11,237 vs kr12,284, respectively. If clinicians use the test 50% of the time for the 30% of the estimated 57,490 people who might have IBS-D who seek treatment, net savings to the Danish healthcare system is kr30,095,980. Cost neutrality occurs if 37% of the “test positive” patients seek IBS treatment.


      This economic evaluation indicates that a positive strategy may be further enhanced with a novel IBS diagnostic blood panel leading to significant cost savings.