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

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...

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Autores: Esteve i Comas, Maria, Rosinach, Mercè, Llordés, Montserrat, Calpe, Judit, Montserrat, Glòria, Pujals, Mar, Cela, Abel, Carrasco García, 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
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2018
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/172457
Acceso en línea:https://hdl.handle.net/2445/172457
Access Level:acceso abierto
Palabra clave:Malaltia celíaca
Diagnòstic
Celiac disease
Diagnosis
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spelling Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care testEsteve i Comas, MariaRosinach, MercèLlordés, MontserratCalpe, JuditMontserrat, GlòriaPujals, MarCela, AbelCarrasco García, AnnaIbarra, MontserratRuiz Ramirez, PabloTristán, EvaArau, BeatrizFerrer, CarmeMariné, MeritxellRibes Puig, JosepaFernández Bañares, FernandoPrimary Care Coeliac Disease Study GroupMalaltia celíacaDiagnòsticCeliac diseaseDiagnosisBackground: 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.SAGE Publications2020202020182020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion11 p.application/pdfapplication/pdfhttps://hdl.handle.net/2445/172457Articles publicats en revistes (Ciències Clíniques)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1177/2050640618761700United European Gastroenterology Journal, 2018, vol. 6, num. 6, p. 855-865https://doi.org/10.1177/2050640618761700cc by-nc (c) Esteve i Comas, Maria et al., 2018http://creativecommons.org/licenses/by-nc/3.0/es/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/1724572026-05-29T05:05:01Z
dc.title.none.fl_str_mv Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test
title Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test
spellingShingle Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test
Esteve i Comas, Maria
Malaltia celíaca
Diagnòstic
Celiac disease
Diagnosis
title_short Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test
title_full Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test
title_fullStr Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test
title_full_unstemmed Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test
title_sort Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test
dc.creator.none.fl_str_mv Esteve i Comas, Maria
Rosinach, Mercè
Llordés, Montserrat
Calpe, Judit
Montserrat, Glòria
Pujals, Mar
Cela, Abel
Carrasco García, 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
author Esteve i Comas, Maria
author_facet Esteve i Comas, Maria
Rosinach, Mercè
Llordés, Montserrat
Calpe, Judit
Montserrat, Glòria
Pujals, Mar
Cela, Abel
Carrasco García, 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
author_role author
author2 Rosinach, Mercè
Llordés, Montserrat
Calpe, Judit
Montserrat, Glòria
Pujals, Mar
Cela, Abel
Carrasco García, 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
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Malaltia celíaca
Diagnòstic
Celiac disease
Diagnosis
topic Malaltia celíaca
Diagnòstic
Celiac disease
Diagnosis
description 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.
publishDate 2018
dc.date.none.fl_str_mv 2018
2020
2020
2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/172457
url https://hdl.handle.net/2445/172457
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1177/2050640618761700
United European Gastroenterology Journal, 2018, vol. 6, num. 6, p. 855-865
https://doi.org/10.1177/2050640618761700
dc.rights.none.fl_str_mv cc by-nc (c) Esteve i Comas, Maria et al., 2018
http://creativecommons.org/licenses/by-nc/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by-nc (c) Esteve i Comas, Maria et al., 2018
http://creativecommons.org/licenses/by-nc/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 11 p.
application/pdf
application/pdf
dc.publisher.none.fl_str_mv SAGE Publications
publisher.none.fl_str_mv SAGE Publications
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,81155

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