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What is the cost of delayed diagnosis of bile acid malabsorption and bile acid diarrhoea?
  1. Darren C R Fernandes1,
  2. Dennis Poon1,
  3. Laura L White2,
  4. H Jervoise N Andreyev1
  1. 1Department of Gastroenterology, Lincoln County Hospital, Lincoln, UK
  2. 2Department of Medical Diagnostics, Lincoln County Hospital, Lincoln, UK
  1. Correspondence to Dr H Jervoise N Andreyev, Department of Gastroenterology, Lincoln County Hospital, Lincoln LN2 5QY, UK; j{at}andreyev.demon.co.uk

Abstract

Introduction 75Selenium taurocholic acid (SeHCAT) scanning diagnoses bile acid malabsorption/bile acid diarrhoea (BAM/BAD) and defines optimal treatment. Approximately 2% of the population have BAM/BAD.

Aim To evaluate the cost of delayed diagnosis of BAM/BAD.

Methods Patients’ notes who underwent SeHCAT scanning in three hospitals over a 1-year period were reviewed retrospectively. Scan results and treatment response were recorded. Package-of-care costs were calculated using costing tools from the National Institute for Health and Care Excellence and from United Lincolnshire Hospitals Trust business unit.

Results Between June 2016 and May 2017, 19 men and 37 women (median age 58 (range 19–83)) of 3860 new patients seen in gastroenterology clinics were referred for SeHCAT scanning. Sixty-four per cent of scans were abnormal: 13 demonstrated severe (<5% 7-day SeHCAT retention), 13 moderate (5%–10%), 5 mild (10%–15%) and 5 borderline (15%–20%) BAD/BAM. Likely causes included primary BAD (n=16), cholecystectomy (n=13), inflammatory bowel disease (n=4) and other (n=3). If SeHCAT scanning was ordered at first consultation (n=11), patients reported 24 months (median) of symptoms (range 6–360) and the median diagnostic package-of-care cost was £811.40 (95% CI £625.59 to £1508.20). If SeHCAT scanning was booked later (n=25), patients reported symptoms for 30 months (median, range 0.5–360) and the cost was £1568.31 (95% CI £1200.55 to £1713.18). Following diagnosis, treatment led to symptom improvement (n=24), no change/deterioration (n=3) and not reported (n=9).

Conclusions SeHCAT is underused. Late diagnosis leads to unnecessary demands for other services and treatment delay. Early diagnosis achieves health benefits while reducing costs.

  • bile
  • cost-effectiveness
  • diarrhoeal disease
  • health economics
  • irritable bowel syndrome

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Footnotes

  • Contributors DCRF and DP helped develop the study concept, collected and analysed the data, wrote the first draft of the manuscript and approved the final version. LLW conceived and develop the study, identified the patients, contributed to the first draft of the manuscript and approved the final version. HJNA conceived and developed the study, contributed to all versions of the manuscript, edited the manuscript and is the study guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests HJNA has received honoraria as a speaker and consultant for GE (manufacturer of SeHCAT) and Sanofi Aventis/Genzyme (manufacturers of colesevelam)

  • Patient consent Not required.

  • Ethics approval This study was approved by the audit committee for our trust.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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