Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test. Issue 6 (July 2018)

• Record Type: Journal Article
• Authors: Esteve, Maria; Rosinach, Mercè; 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, Josepa; Fernández-Bañares, Fernando
• Is Part Of: United European Gastroenterology journal. Volume 6:Issue 6(2018)
• Page Start: 855
• Page End: 865
• Publication Date: 2018-07
• Subjects: Coeliac disease -- diagnosis -- serology -- point-of-care test; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640618761700
• Languages: English
• ISSNs: 2050-6406

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: €13, 033/case; POCT + duodenal biopsy: €7360/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.