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Title: Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test
Author: Esteve i Comas, Maria
Rosinach, Merce
Llordés, Montserrat
Calpe, Judit
Montserrat, Glòria
Pujals, Mar
Cela, Abel
Carrasco, Anna
Ibarra, Montserrat
Ruiz Ramirez, Pablo
Tristán, Eva
Arau, Beatriz
Ferrer, Carme
Mariné, Meritxell
Ribes Puig, Josepa
Fernández Bañares, Fernando
Primary Care Coeliac Disease Study Group
Keywords: Malaltia celíaca
Celiac disease
Issue Date: 1-Jul-2018
Publisher: SAGE Publications
Abstract: Background: An on-site, rapid, fingertip, whole-blood point-of-care test (POCT) is attractive for active case-finding of coeliac disease (CD) in primary care because of its simplicity. Aim: The aim of this article is to assess the usefulness and cost-effectiveness of adult case-finding using a POCT based on deamidated gliadin peptide antibodies (IgA/IgG-DGP) in primary care for CD diagnosis. Methods: A case-finding study for CD was conducted by using an easy-to-use, on-site, whole-blood for IgA/IgG-DGP-based fingertip POCT compared with tTG2 in 350 individuals. Sample size was calculated based on 0.28% prevalence in the reference population. Duodenal biopsies for histology, intraepithelial lymphocytes and in situ deposition of tTG2 were obtained if tTG2 and/or POCT were positive. Accuracy and cost-effectiveness of strategies using serology or POCT were calculated. Results: Prevalence of CD was 1.14% (95% CI, 0.3-3.4), almost double what was previously observed. Four patients were diagnosed with CD. tTG2 was positive in three (0.85%) and POCT in 29 (8.2%). Sensitivity of POCT for CD was 100%, specificity 93%, PPV 14%, and NPV 100%. POCT followed by duodenal biopsy was the most cost-effective approach in our setting (standard diagnosis: E13,033/case; POCT þ duodenal biopsy: E7360/case). Conclusions: A negative POCT allows ruling out CD in primary care, making it suitable for case-finding. POCT strategy was the most cost effective.
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It is part of: United European Gastroenterology Journal, 2018, vol. 6, num. 6, p. 855-865
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ISSN: 2050-6406
Appears in Collections:Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
Articles publicats en revistes (Medicina)
Articles publicats en revistes (Ciències Clíniques)

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