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Cost-Minimization For A Novel Ibs Diagnostic Blood Panel Versus Standard Exclusionary Diagnostic Testing For Diarrhea Predominant Irritable Bowel Syndrome: A United States Perspective

      Objectives

      The diagnosis of diarrhea predominant irritable bowel syndrome (IBS-D) is based on clinical presentation and several laboratory and diagnostic procedures to exclude other organic conditions. A novel IBS diagnostic blood panel has been developed which tests for the presence of two biomarkers associated with IBS-D. This study assesses the cost implications associated with introducing this test into the diagnostic pathway.

      Methods

      A cost-minimization (CM) decision tree model was constructed to compare the costs associated with two possible diagnostic pathways: (1) diagnostic pathway with novel IBS diagnostic blood panel and (2) exclusionary diagnostic pathway (i.e. standard of care). Model structure was based on current literature and guidance from IBS expert clinicians. Costs for resources were derived from public sources. One and two-way sensitivity analyses were performed for key input variables. Budget impact analysis extrapolates results of the (CM), using prevalence data, to a health plan with 1 million covered lives. An alternate time-dependent model addresses the impact associated with the sequencing of diagnostic tests.

      Results

      The CM model predicts a base-case savings of $280 per patient for the diagnostic pathway that includes the novel IBS diagnostic blood panel. Sensitivity analyses predict a range of cost savings of $120 - $439. Budget impact analysis predicts a base case savings of $1,080,232 to the plan or $0.09 on a per member per month basis for the diagnostic pathway with the novel IBS diagnostic blood panel. The time dependent model indicates that the potential cost savings associated with the novel IBS blood test are attenuated over time.

      Conclusions

      Current literature suggests that extensive diagnostic testing to diagnose IBS is not necessary. This economic evaluation indicates that the inclusion of a novel IBS diagnostic blood panel in the diagnostic process has the potential for significant cost savings due to the avoidance of unnecessary testing.