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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Authors: 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
Format: article
Status:Published version
Publication Date:2018
Country:España
Institution:Universidad de Barcelona
Repository:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/172457
Online Access:https://hdl.handle.net/2445/172457
Access Level:Open access
Keyword:Malaltia celíaca
Diagnòstic
Celiac disease
Diagnosis
Description
Summary: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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