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684837.pdf (510.73 KB)

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2018-07-01

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cc by-nc (c) Esteve i Comas, Maria et al., 2018
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/172457

Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test

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https://doi.org/10.1177/2050640618761700

Resum

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.

Matèries

Malaltia celíaca, Diagnòstic

Matèries (anglès)

Celiac disease, Diagnosis

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Articles publicats en revistes (Ciències Clíniques)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
Articles publicats en revistes (Medicina)

Citació

ESTEVE I COMAS, Maria, et al. Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test. United European Gastroenterology Journal. 2018. Vol. 6, num. 6, pags. 855-865. ISSN 2050-6406. [consulted: 16 of August of 2026]. Available at: https://hdl.handle.net/2445/172457

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