Abstract
Background: Triage of children with chronic abdominal symptoms who benefit from pediatric specialist care is challenging for general practitioners (GPs). Aim: To evaluate (cost-)effectiveness of fecal calprotectin (FCal)-testing to guide referral to specialist care in children with chronic abdominal symptoms. Methods: Pragmatic, cluster-randomized controlled trial with 1:1 randomization of Dutch GP practices between October 2019 and July 2021. GPs in the intervention group followed an FCal-guided referral strategy and the control group Dutch GP guidelines, which do not recommend FCal-testing. Eighty-four GP practices included 405 children aged 4-18 years with chronic abdominal pain and/or diarrhoea. Primary outcome was specialist referral within 6 months after baseline consultation. Incremental cost-effectiveness ratios (ICERs) were calculated from the societal perspective based on parental concern. Intention-to-treat (ITT) analyses and per-protocol (PP) analyses (strategy adherence in intervention group and no FCal use in control group) were conducted. Results. Adherence to FCal-strategy was 59%. Alarm symptoms for IBD were more prevalent in the intervention (26.6%) than the control group (8.9%) with similar referral rates in the ITT analysis (22.8 vs 21.9%; adjusted odds ratio (aOR) 0.94, 95%CI 0.57-1.54) and fewer referrals for the intervention group in the PP analysis (5.8% vs 20.3%; aOR 0.21, 95%CI 0.09-0.50). The intervention was not cost-effective in the ITT analysis (ICER €1534; 95%CI -€9019-€9579), but cost-effective in the PP analysis (ICER -€344; 95 %CI -€4609-€3096). Conclusion. The results do not justify recommending FCal testing in children in primary care without proper implementation. Additional research should focus on improving adherence to the FCal-strategy.
- Received May 30, 2025.
- Accepted September 25, 2025.
- Copyright © 2025, The Authors
