A Predictive Model to Estimate Cost Savings of a Novel Diagnostic Blood Panel for Diagnosis of Diarrhea-predominant Irritable Bowel Syndrome

• Published in: Clinical therapeutics Vol. 38; no. 7; pp. 1638 - 1652.e9
• Main Authors: Pimentel, Mark, MD, FRCP(C), Purdy, Chris, MA, Magar, Raf, MBA, Rezaie, Ali, MD, MSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016; Elsevier Limited
• Subjects: Abdomen; Biomarkers; Biomarkers - blood; Blood; budget impact analysis; Celiac disease; Colonoscopy; Constipation; Cost control; Cost Savings; cost-minimization; Decision Trees; Diagnostic tests; Diarrhea; Diarrhea - blood; Diarrhea - diagnosis; Diarrhea - economics; diarrhea-predominant irritable bowel syndrome; Endoscopy; Humans; Hydrogen; IBS diagnostic blood panel; Inflammatory bowel disease; Internal Medicine; Irritable bowel syndrome; Irritable Bowel Syndrome - blood; Irritable Bowel Syndrome - diagnosis; Irritable Bowel Syndrome - economics; Laboratories; Liver; Medical Education; Occult sciences; Patients; Probability; Proteins; Sensitivity analysis; Sensitivity and Specificity; Studies; Thyroid gland; Tomography; Ultrasonic imaging; cost-minimization; budget impact analysis; colonoscopy; diarrhea-predominant irritable bowel syndrome; IBS diagnostic blood panel
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2016.05.003

Abstract Purpose A high incidence of irritable bowel syndrome (IBS) is associated with significant medical costs. Diarrhea-predominant IBS (IBS-D) is diagnosed on the basis of clinical presentation and diagnostic test results and procedures that exclude other conditions. This study was conducted to estimate the potential cost savings of a novel IBS diagnostic blood panel that tests for the presence of antibodies to cytolethal distending toxin B and anti-vinculin associated with IBS-D. Methods A cost-minimization (CM) decision tree model was used to compare the costs of a novel IBS diagnostic blood panel pathway versus an exclusionary diagnostic pathway (ie, standard of care). The probability that patients proceed to treatment was modeled as a function of sensitivity, specificity, and likelihood ratios of the individual biomarker tests. One-way sensitivity analyses were performed for key variables, and a break-even analysis was performed for the pretest probability of IBS-D. Budget impact analysis of the CM model was extrapolated to a health plan with 1 million covered lives. Findings The CM model (base-case) predicted $509 cost savings for the novel IBS diagnostic blood panel versus the exclusionary diagnostic pathway because of the avoidance of downstream testing (eg, colonoscopy, computed tomography scans). Sensitivity analysis indicated that an increase in both positive likelihood ratios modestly increased cost savings. Break-even analysis estimated that the pretest probability of disease would be 0.451 to attain cost neutrality. The budget impact analysis predicted a cost savings of $3,634,006 ($0.30 per member per month). Implications The novel IBS diagnostic blood panel may yield significant cost savings by allowing patients to proceed to treatment earlier, thereby avoiding unnecessary testing.