Introduction of faecal calprotectin testing into the UK inflammatory bowel disease diagnostic pathway reduces environmental burden
Emily Archer Goode, Amy Swanston, John Bridgewood, Henry Swales, Antony Wright, Lindsay Nicholson
Abstract
Objectives
This study aims to quantify GHG emissions associated with the UK IBD diagnosis pathway with and without FCP testing.
Background
Inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis, are chronic inflammatory diseases of the gastrointestinal tract.The prevalence of IBD is rising, making timely and improved diagnosis increasingly important. The IBD diagnosis pathway involves several diagnostic tests and substantial use of physician time and healthcare resources. Faecal calprotectin (FCP) testing for IBD diagnosis in the primary care setting is recommended by the National Institute for Health and Care Excellence (NICE) (DG11)and by IBD UK. However, uptake in clinical practice has been limited.The United Kingdom (UK) has set targets to decarbonise the National Health Service and achieve net-zero by 2030–2045. Sustainable changes to clinical practice that maintain or enhance patient outcomes while reducing environmental impact are crucial to achieving this goal. The use of FCP testing in the diagnosis of IBD reduces secondary care referrals and endoscopic investigations, with potential concomitant savings of greenhouse gas (GHG) emissions.
Methods
The UK IBD diagnosis pathway was mapped over one-year according to current clinical practice and published guidelines. Pre-diagnosis hospitalisation is one of the most significant contributors to carbon dioxide equivalents (CO2e) in the IBD diagnosis pathway. However, this was not captured in this model due to a lack of published data on the potential reduction in pre-diagnosis hospitalisation following FCP testing implementation. Data on the potential change in diagnostic imaging usage (other than endoscopic investigation) with FCP testing was also not captured in this study. Where UK data was unavailable, data from other countries were used as proxies. Changes in secondary care referrals and diagnostic imaging tests following the adoption of FCP testing in the primary care setting were derived from published literature.
Results
The total GHG emissions associated with the IBD diagnosis pathway without FCP testing over one-year in the UK was estimated at 4,606 tonnes of CO2e. Published literature suggests that implementation of FCP testing in primary care could reduce secondary care referrals by 53.73%, and endoscopic investigations by 48.37%. Following NICE recommendations to implement FCP testing could reduce GHG emissions by 495.66 tonnes CO2e annually; which is equivalent to a 10.76% reduction in CO2e compared to the UK IBD diagnostic pathway without FCP testing
Conclusion
FCP testing confers patient benefit by reducing the time to IBD diagnosis and treatment, in addition to avoiding the need for secondary care referrals and invasive biopsy in a high proportion of patients. Moreover, implementing FCP testing in the primary care setting substantially reduces GHG emissions by avoiding unnecessary secondary care referrals and endoscopic investigations. Optimising care pathways can improve patient outcomes, as well as aiding healthcare systems to meet their net zero targets.