Background: In recent years, several new investigations to aid diagnosis and monitoring of IBD have become available. These include faecal calprotectin (FC), widely regarded as a surrogate for intestinal inflammatory activity and therapeutic drug monitoring (TDM) for thiopurine metabolites and anti-TNF therapy. However, uptake and access has not been uniform. We aimed to assess barriers to access of these investigations.
Methods: Questionnaires were distributed to delegates at the 11th Congress of ECCO. Analysis of responses was performed using R statistical software including binomial linear regression analysis for potential barriers to access, including health economic data extracted from the WHO Global Health Expenditure database. https://planner.smart-abstract.com/ecco2017/submission/en/abstract/3800/content#
Results: 195 valid responses were obtained from participants from 38 countries, including paediatricians (14%), adult gastroneterologists (42%) and gastroenterologists-in-training (35%). 135 (39%) of respondents were practicing in an academic hospital. High volume IBD work (≥1IBD patient/day) was reported by 61.8%.
FC was available to 92.3%, most using at least weekly (80.3%). Access to anti-TNF TDM was less widespread (78.9%; p=0.0002) and less heavily used (45.8% using at least weekly; p<0.0001). Access to TDM for infliximab was better than for adalimumab (p=0.0004). Thiopurine TDM was least widely available (67.7%; p=0.0001 vs FC, p=0.02 vs anti-TNF TDM) but used at an intermediate level where available (56.5% reporting at least weekly usage; p<0.01 vs both other groups). There was heterogeneity and lack of consensus when asked to identify situations where they might use each investigation.
Access to all 3 investigations within Europe showed a significant East (E)–West (W) and North (N)–South (S) divide. For FC we found W vs E: 95.1% vs 82.0% (p=0.04) and N vs S: 97.3% vs 80.4% (p=0.001), with similar statistically significant comparisons for both other tests.
Multivariable analysis showed that the strongest independent predictors of access to all 3 tests was health-care spending per capita (p=0.005 for FC; p<0.0001 for both TDM). Working in an academic centre was an independent predictor of access to TDM (p=0.03 for anti-TNF; p=0.02 for thiopurine). Respondents were more likely to cite cost as a barrier to accessing anti-TNF TDM (30.8%) or FC (24.6%) than thiopurine TDM (12.3%; p<0.0001 and 0.003).
Conclusions: Investigations for the purpose of personalizing therapy have revolutionized IBD care. FC, anti-TNF and thiopurine TDM have been incorporated into routine practice in much of Europe. Increased healthcare spending in IBD care with a focus on Eastern and Southern European countries may improve access to these integral investigations.
 Burisch et al. Epi-COM group, (2014), East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort, GUT, 588–97