Targeted bowel prep can reduce repeated colonoscopies

SAN DIEGO — Using prediction models to target those at high risk for failing colonoscopy preparation and administering a 2-day preparation up-front can reduce the number of repeat colonoscopies, according to a study presented at Digestive Disease Week 2016.

“Failed bowel prep is a common problem,” Jacob E. Kurlander, MD, gastroenterologist in the University of Michigan health system, said during a presentation. “There's approximately 11.5 million colonoscopies in the U.S. every year and a sixth of them are affected by inadequate bowel preparation equating to nearly 2 million colonoscopies annually.”

Normally, patients who fail standard bowel prep must redo their colonoscopy along with an extended 2-day prep, the researchers wrote.

Kurlander and colleagues developed a decision analytic model to compare normal prep with a targeted strategy. In the targeted strategy, high-risk patients were initially given 2-day prep, whereas low-risk patients received normal 1-day prep. The researchers calculated the number of days preparing for or undergoing colonoscopy and the cost of care per patient. In addition, they performed a sensitivity analysis.

The researchers found that the targeted strategy only slightly increased the time preparing for or undergoing colonoscopy (2.56 days) vs. normal prep (2.51 days), but significantly decreased the cost per patient ($1,243) compared with normal prep ($1,334). In the sensitivity analysis, the targeted strategy cost less than normal prep across the entire plausible range of prep failure risk.

Using current prediction models, a targeted bowel prep strategy is likely to save money, with little effect on the amount of time patients have to spend on prep, the researchers wrote.

“The president’s council of advisors on science and technology has defined precision medicine as the ability to classify individuals of the sub-populations that differ in their susceptibility to a particular disease or their response to a specific treatment, which can then be concentrated on those who will benefit most,” Kurlander said. “So, if we could give a targeted bowel preparation to certain patients, that would be bringing prep into the precision medicine age.” – by Will Offit

Reference:

Kurlander JE, et al. Abstract #255. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

Disclosure: Kurlander reports receiving grant funding from Ironwood Pharmaceuticals.