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Faecal calprotectin testing finally on the MBS

Faecal calprotectin testing to diagnose inflammatory bowel disease will be added to the MBS from 1 November 2021.

Faecal calprotectin testing to diagnose inflammatory bowel disease will be added to the MBS from 1 November 2021.

The long-awaited additions to the MBS are new items 66522 and 66523.

“A service under these items will be available to patients who are less than 50 years of age presenting with gastrointestinal symptoms suggestive of inflammatory or functional bowel disease with more than six weeks duration,” the MBS said.

As previously reported in the limbic last year, the MSAC approved the listing of faecal calprotectin (FC) testing for the differential diagnosis of IBD from IBS in adults and IBD from non-IBD in children.

“MSAC recommended that faecal calprotectin testing be publicly funded because it is safe and effective, it will lead to fewer people needing a colonoscopy and it is much cheaper and less invasive for patients than a colonoscopy,” the MSAC Public Summary said.

MSAC further recommended that the frequency of colonoscopy testing be monitored to see if fewer tests are ordered as anticipated.

Professor Jane Andrews, Medical Lead for Gastroenterology, General & GI Surgery for the Central Adelaide Local Health Network, told the limbic the years of delay getting FC testing listed on the MBS was unfortunate.

“And then we got a positive recommendation for it early last year but COVID hit. All of this last 20 months of delay is COVID-related. Ironically, it’s a test that is really great at triage for who does and doesn’t need a colonoscopy so it would have been helpful to have it fast tracked during COVID.”

Professor Andrews said FC testing was an effective triage tool which enabled a faster, more confident diagnosis of IBS and helped avoid colonoscopy in people who don’t need it.

“It’s great value is in its negative predictive ability. In an otherwise healthy young person with symptoms longer than 6 weeks, it’s really good at saying, you’ve got IBS. Let’s get on with some dietary management, reassurance, stress management, mental health, etc.”

“FC is really good in the under 50s…to pull out the people that we need to scope and to push back to primary care the people that we don’t need to scope.”

She stressed that FC testing should not be used in people over 50 years when it was more important to be screening with an immunochemical faecal occult blood test for polyps or early colorectal cancer.

Similarly, FC testing should also not be used in people with obvious rectal bleeding or those with other alarms such as high CRP, significant weight loss or iron deficiency.

“Again, this is not the most helpful test in that setting because you already should be thinking that person is sick and needs specialist referral.”

She added that FC testing shouldn’t be used in people with acute symptoms of less than 6 weeks duration because infection is the most common cause for non-specific lower GI symptoms.

Original source here.

Posted on: October 26 2021

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