Experts say the new Medicare item for faecal calprotectin testing is a vital step, but limiting access to symptomatic patients misses key preventive benefits.
Australian inflammatory bowel disease experts have welcomed the imminent introduction of a Medicare Benefits Schedule item for faecal calprotectin testing – but warn the scope of the decision has not gone far enough.
Under the new arrangements, FC testing (item 66525) can be requested by a specialist or consultant physician, or by any medical practitioner provided the patient is under specialist care.
The test will be listed under Category 6 – Pathology Services, Group P2 – Chemical, with a schedule fee of $75.00 and benefits of $56.25 (75%) and $63.75 (85%).
This item complements existing MBS items 66522 and 66523, which are used for diagnosing IBD. Item 66522 may be requested by general practitioners to assist with diagnosis, while item 66523 applies to specialist gastroenterologists when an initial FC test result is inconclusive.
As with other FC items, testing must be performed by approved pathology practitioners.
Gastroenterologist and IBD expert Professor Jane Andrews, chair of Crohn’s Colitis Cure (CCCure) and co-chair of the global IBD consortium GLIDE, said the new MBS item was a welcome advance – but too narrow and overlooked the broader benefits of early, proactive care.
She said she was disappointed that MSAC did not extend the item to asymptomatic IBD patients.
“It’s not that we’re not happy to have got this MBS indication,” she told Gut Republic.
“It’s just that it’s 50% of what we think is required.”
Professor Andrews said FC testing’s value extended far beyond identifying disease flares.
“It’s actually very good for being able to do, for example, remote monitoring. So if you’ve got people who live at distance from a centre, if they’ve got no symptoms and their calpro is low, then you know they don’t need to travel 300km to come and see you,” she said.
“We also know that if your calpro is low, that you’re really unlikely to have a flare in the next 12 months. We know that it creeps up ahead of a flare.
“And we know that if you intervene with therapy before someone’s symptomatic when it’s creeping up, that you can prevent flares.
“All of this is known, so the whole idea to us is that calpro is an ideal tool to be used for proactive care, to give you early warning signs, and also the converse, to provide reassurance, because there are a lot of people who are anxious.”
Related
Professor Andrews said faecal calprotectin testing was an ideal proactive tool that could reduce unnecessary endoscopies, travel, and patient anxiety.
“Having calpro available to reduce anxiety and to reduce endoscopies and radiology events and travel events is an important thing,” she said.
Professor Andrews urged GPs to make use of the FC testing for their IBD patients.
“Our recommendation as IBD experts is that most people with inflammatory bowel disease should be having some regular non interventional monitoring and probably a six-monthly calpro is a very reasonable thing regardless of symptoms, because some people will have active disease with no symptoms, and some people will have symptoms but they will not have active disease,” she said.
“Calpro is much cheaper and easier. Easier than endoscopy, colonoscopy, MRI, and CT scanning. Less imaging, more calpro keeps people out of hospital.”
The application for the new MBS item was made by the Gastroenterological Society of Australia for the listing of FC testing for the monitoring of disease activity in patients with IBD and considered by Medical Services Advisory Committee (MSAC) in November 2024.
According to the public summary document detailing its advice to the federal health minister, the committee considered “the strength of the available evidence in relation to comparative safety, clinical effectiveness, cost-effectiveness and total cost”.
“MSAC supported the creation of a new Medicare Benefits Schedule (MBS) item for faecal calprotectin (FC) testing for the management of symptomatic patients with inflammatory bowel disease (IBD),” the committee said in its advice.
“MSAC did not support public funding of FC testing for the monitoring of asymptomatic patients with IBD.
“MSAC considered general practitioners (GPs) should be able to request FC testing on behalf of a specialist or consultant physician.”
MSAC said it considered FC testing had clinical utility for symptomatic patients as it could help detect whether symptoms were due to increased IBD activity and monitor healing after an IBD flare.
“MSAC considered the clinical utility of FC testing for asymptomatic patients was highly uncertain due to limited evidence that using the test would change management and improve health outcomes in this subpopulation,” it said in the advice.
“MSAC considered that the claim of non-inferior comparative safety of FC testing was not supported for asymptomatic patients given the high rate of false positive FC results, which may lead to unnecessary escalation of therapy or additional colonoscopy and potentially expose this group to the adverse effects of these interventions.”
MSAC said it consulted widely during the assessment process, drawing input from key professional, clinical and consumer groups including the Therapeutic Goods Administration, the Royal College of Pathologists of Australasia, Australian Pathology, the Gastroenterological Nurses College of Australia, Crohn’s and Colitis Australia, Public Pathology Australia, the National Pathology Accreditation Advisory Council, the Gastroenterological Society of Australia, the Royal Australian College of General Practitioners, DiaSorin Australia and Crohn’s Colitis Cure.
Professor Andrews said she would like to see the introduction of access to subsidised home FC testing.
“In a country like Australia, we generate a lot of productivity loss and a lot of healthcare-related emissions because of people traveling a long way to see a doctor,” she said.
“And if we could have remote digital monitoring with calpro as part of the algorithm, we could save a lot of issues for regional and rural health development and delivery, so people can, you know, do them at home and upload results on your phone.”
More information about item 66525 and other upcoming MBS changes is available on the MBS Online website.
