Open AccessCase‐finding in primary care for coeliac disease: Accuracy and cost‐effectiveness of a rapid point‐of‐care test
Author(s) -
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
Publication year - 2018
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640618761700
Subject(s) - point of care testing , medicine , coeliac disease , serology , point of care , population , disease , pathology , immunology , antibody , environmental health
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.