P476 Using small bowel and colon video capsule endoscopy to optimise Crohn's disease therapy may improve patient quality of life. (16th January 2018) - Saunders, R
Abstract: Background: Video capsule endoscopy (VCE) is a widely accepted technology that has application for monitoring of patients diagnosed with Crohn's disease (CD). Due to the chronic nature of CD, using endoscopic monitoring to optimise treatment may have a considerable impact on both care costs and patient's quality of life (QoL). This study aims to identify patient subgroups who may benefit from the use of pan-intestinal VCE. Methods: Extended analysis of patient outcomes of a previously published, patient-level, care pathway model that is specific to CD. In the model, treatment and monitoring can influence the onset, progression, or remission of CD flares, fistula, abscess, bowel resection, and death. The model compares outcomes with VCE to the current common monitoring practice of colonoscopy ± MRE or CTE. Data for VCE were derived from PillCam (Medtronic Inc.), which can assess both the small-bowel and colon in a single procedure. Outcomes for 40, 000 simulated patients over 20 years were assessed. Cost of care and patient QoL were compared between monitoring options and stratified by patient subgroup. Subgroups based on the patient's initial health state in the model were: remission, non-active symptomatic, active symptomatic, active non-symptomatic, treatment, treatment failure, surgery, or post-surgery. All subgroups were mutually exclusive. Differences between groups were quantified by the Wilcoxon-signed rank and the odds ratio (OR) with significance at the 95% level ( p < 0.05). Results: Overall, patients had significantly lower costs ( p < 0.001) and higher QoL ( p < 0.001) with use of VCE compared with common monitoring practice. Even patients in remission, the state with the least benefit from VCE, saw QoL improvement in 68% of cases. Patients in an active symptomatic or post-surgical state were the most likely to experience QoL improvement (both 79%). All groups displayed a significantly higher chance of QoL improvement over patients in remission (Figure 1). The likelihood of cost-savings was significantly higher during treatment (OR: 1.11, 1.03–1.19) or surgery (OR: 1.27, 1.13–1.41) when compared with remission. Conclusions: Assessing the extent of active CD with small bowel and colon VCE is likely beneficial for patient QoL and may also help reduce care costs. Targeting certain subgroups may amplify the advantages of VCE. Patients in need of more frequent follow-up, such as those on biological treatment, post-surgery, or with active symptoms, may be especially benefited by pan-intestinal VCE.