N34 Could the targeted use of home faecal calprotectin testing increase uptake and help to address cost effectiveness concerns?
Authors: Younge Nurse Cons L , Arebi N , Joseph B , Adio J 
Published: January 2025

Abstract

Background
Home faecal calprotectin testing (HFC) has a role in the management of inflammatory bowel disease (IBD) with faster turnaround times, earlier clinical input, and potentially greater patient engagement. However, despite positive feedback from patients, a previous in-house audit demonstrated a low yield of completed tests (39%)1, raising concerns about cost effectiveness of HFC compared to standard testing. Variation in counselling and heterogeneity in reasons for requesting HFC may have contributed to our results. We wanted to explore if using HFC in a targeted way with standardised counselling could improve completion rates in our centre and identify where HFC might be cost effective.

Methods
3 clinical indications were identified: young adult patients (YA), patients starting advanced therapies (AT) and patients on cancer surveillance (CS). All patients were counselled on the HFC process in a standard way by a limited number of clinicians to minimise variation, including viewing an instruction video online from CalproSmart2, and making patients aware of the cost of HFC in relation to hospital tests. Once counselled, patients were asked to confirm they were happy to do the HFC prior to the kit being sent. Outcomes including completion rates and where available, reasons for non-completion were recorded.

Results
Between July 2023 and August 2024 HFC kits were sent to 70 individual patients (Table 1).
35/70 HCF were completed (50%). Additionally, 6 patients advised that they did receive and perform their HFC but had issues with the kit or app (8%).
Reminder texts were sent to non-completers, but this did not result in any further tests being completed.
The highest completion rate of HFC, 22/32 (68%) was in the AT indication.
23/70 (33%) HFC results were &gt;250 (range 274-&gt;1500). Of these, 15/23 (65%) patients had changes made to their treatment, ranging from initiation of topical therapy to a switch in AT, within 2 weeks of the result being available.

Conclusion
HFC completion rates improved (58% vs 39%) when patients were more aware of how to do the test, the reason for the investigation and where use was targeted to specific clinical scenarios as part of routine care. When HFC was elevated, clinical decision making was prompt with the potential to identify nonresponse or loss of response to AT in a timely manner, reducing flares and unscheduled admissions. While challenges demonstrating cost effectiveness remain, the benefits of HFC for patients who engage with the process seem evident and warrant ongoing investigation into how best to incorporate into clinical care, particularly as part of at home monitoring to support patient self-management and disease monitoring on advanced therapy.

References
1.P Avery, J Adio, R Cornford, L Younge, N24 At Home Calprotectin a United Kingdom Patient Perspectives and Tertiary Center Experience, Journal of Crohn's and Colitis, Volume 17, Issue Supplement_1, February 2023, Pages i1052–i1053, https://doi.org/10.1093/ecco-jcc/jjac190.1083
2.(CalproSmart Instructional video (youtube.com)