P738 Assessing aCCess to investigations in IBD (ACCID) – results from an international inflammatory bowel disease survey

Abstract

Introduction: In recent years, several new investigations to aid diagnosis and monitoring of inflammatory bowel disease (IBD) have become available. These include fecal 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 have not been uniform. We aimed to assess barriers to access of these investigations. Method(s): Questionnaires were distributed to delegates at the 11th Congress of the European Crohn's and Colitis Organisation. 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 World Health Organization Global Health Expenditure database (https://planner.smartabstract.com/ecc02017/ submission/en/abstract/3800/content#). A total of 195 valid responses were obtained from 38 countries, with the third highest response rate from Australia (11; 6%). Result(s): Access and use varied between tests (Table 1), with near universal availability and use of FC. Access and use of anti-TNF TDM was lower, with better access to TDM for infliximab than for adalimumab (P = 0.0004). Thiopurine TDM was least widely available but was used at an intermediate level where available. There was heterogeneity and lack of consensus when responders were asked to identify situations where each investigation might be used. Access to all three investigations within Europe showed a significant east-west and north-south divide,1 while Australia had access to all three tests in 100% of responses. Factors affecting access to tests were further analyzed by binomial linear regression analysis, which showed that the strongest independent predictor of access to all three tests was health care spending per capita (Table 2). Among Australian responders, all 11 responders cited cost, while five (45%) cited speed of test result as a barrier to the use of anti-TNF TDM. FC was available to 92.3%, most using it 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 was used at an intermediate level where available (56.5% reporting at least weekly usage; P < 0.01 vs both other groups). All Australian responders were able to access and use thiopurine TDM, but barriers to ordering the test remained, including costs for six (55%). There was heterogeneity and lack of consensus when asked to identify situations where each investigation might be used. Multivariable analysis showed that the strongest independent predictor of access to all three tests was health care spending per capita (P = 0.005 for FC; P < 0.0001 for both TDMs). Working in an academic center 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). Conclusion(s): Investigations for the purpose of personalizing therapy have revolutionized IBDcare. FC, anti-TNF, and thiopurineTDMhave been incorporated into routine practice inmuch ofEurope andAustralia. Increased health care spending in IBD care, with a focus on countries and areas with lower health care spending, may improve access to these integral investigations. (Table Presented).