Cost-effectiveness of quantitative fecal lactoferrin assay for diagnosis of symptomatic patients with ileal pouch-anal anastomosis.
OBJECTIVE
To assess cost-effectiveness of fecal lactoferrin (FL) as the initial diagnostic approach to symptomatic patients with ileal pouch-anal anastomosis (IPAA).


METHODS
Four competing strategies [empiric metronidazole therapy (txMTZ), initial pouch endoscopy with biopsy (testBiop), initial FL assay followed by metronidazole therapy (testFL+MTZ), and initial FL assay followed by pouch endoscopy and biopsy (testFL+Biop)] were modeled in a decision tree.


RESULTS
In the base-case, the average cost per patient was $241 for testFL+MTZ, $251 for txMTZ, $405 for testFL+Biop, and $431 for testBiop. The testBiop strategy had greater effectiveness compared with txMTZ but at an incremental cost of $158 per day. The txMTZ strategy was slightly more costly and minimally more effective than testFL+MTZ with an incremental cost effectiveness of just over $12 per day. However, the testFL+MTZ strategy was associated with a 31% absolute reduction in antibiotic exposure compared with the txMTZ strategy.


CONCLUSIONS
Compared with empiric metronidazole therapy, FL before treatment with metronidazole is less costly with less exposure to antibiotics and less need for endoscopy, with only marginal decrease in effectiveness.
Parsi
Mansour A
MA
Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio 44195, USA. parsim@ccf.org
Ellis
Jeffrey J
JJ
Lashner
Bret A
BA
D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use; D001706:Biopsy / Q000191:economics; D039021:Colonic Pouches / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000175:diagnosis*; D003663:Decision Trees; D004724:Endoscopy / Q000191:economics; D005243:Feces / Q000737:chemistry*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007781:Lactoferrin / Q000032:analysis* / Q000191:economics*; D008795:Metronidazole / Q000191:economics / Q000627:therapeutic use; D019449:Pouchitis / Q000175:diagnosis*
D000890:Anti-Infective Agents; D008795:Metronidazole; D007781:Lactoferrin