P475 - DEVELOPMENT OF A NOVEL ADULT INTESTINAL FAILURE DISEASE ACTIVITY INDEX (IF-DAI) USING EXPERT ITERATIVE CONSENSUS (DELPHI) AND MULTI-CRITERIA DECISION ANALYSIS (MCDA) USING MACBETH

P475

DEVELOPMENT OF A NOVEL ADULT INTESTINAL FAILURE DISEASE ACTIVITY INDEX (IF-DAI) USING EXPERT ITERATIVE CONSENSUS (DELPHI) AND MULTI-CRITERIA DECISION ANALYSIS (MCDA) USING MACBETH

K. Iyer^1,*, M. Winkler², S. Kakani³, K. Tappenden⁴, M. Mundi⁵, R. Friebel⁶, M. Nisenholtz¹, A. Santos⁷, J. Costa⁷

¹Surgery/Transplant, Mount Sinai Hospital;, New York, ²Surgery/Nutrition, Rhode Island Hopspital, Providence, ³Patient Advocacy, Alabama Rare, Huntsville, ⁴Nutrition, University of Utah, Salt Lake City, ⁵Medicine, Mayo Clinic, Rochester, United States, ⁶Health Policy, London School of Economics, London, United Kingdom, ⁷Decision Analysis, DecisionEyes, Lisbon, Portugal

Rationale: Intestinal failure (IF) requires intravenous fluids, electrolytes, and nutrition supplementation to maintain health and can be associated with significant morbidity and mortality.  There is considerable heterogeneity in management of IF depending on the level of expertise of the managing team.  An objective index or scoring system for clinical activity of IF would allow for standardization in monitoring and management of patients with IF.

Methods: Novel IF disease activity index (IF-DAI) was developed utilizing iterative expert consensus through an online Delphi process hosted by Decision Eyes (https://www.decisioneyes.com/ ), summarized in Figure 1. Of 52 international experts, there were 19 physicians, 18 allied health clinicians and 15 patients/patient advocates.  Experts selected from clinical criteria and only had access to the opinion of other experts at the conclusion of each round. To develop the scores and weights for individual criteria, we used the Measuring Attractiveness by a Categorical Based Evaluation Technique (MACBETH) approach.

Results: Expert participation rate in the first 4 rounds was high (73 – 82%). Of 16 initial criteria, after revisions based on expert input, the final IF-DAI comprises of 11 clinical criteria (Figure 1 - Table). Final reference scores and weights for the different criteria are currently being developed using MACBETH.

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Conclusion: We have developed a novel IF-DAI reflecting baseline clinical severity of IF. The IF-DAI is designed to be sensitive to short- and medium-term changes in clinical activity. The IF-DAI will be validated in a large cohort of IF patients over a 6-month period at the start of an upcoming LIFT-ECHO randomized controlled trial.

Disclosure of Interest: K. Iyer Grant / Research Support from: Takeda Pharmaceutical; Ironwood Pharmaceutical; Northsea Pharmaceutical, Consultant for: Ironwood Pharmaceutical; Northsea Pharmaceutical, M. Winkler: None declared, S. Kakani: None declared, K. Tappenden: None declared, M. Mundi: None declared, R. Friebel: None declared, M. Nisenholtz: None declared, A. Santos: None declared, J. Costa: None declared