Diagnostic Yield of 2 Strategies for Adult Celiac Disease Identification in Primary Care

Abstract

Goals:To compare the diagnostic yield and cost-consequences of 2 strategies, screening regardless of symptoms versus case finding (CF), using a point-of-care test (POCT), for the detection of celiac disease (CD) in primary care, to bridge the diagnostic gap of CD in adults. Materials and Methods:All subjects under 75 years of age who consecutively went to their general practitioners' offices were offered POCT for anti-transglutaminase immunoglobulin A antibodies. The POCT was performed on all subjects who agreed, and then a systematic search for symptoms or conditions associated with higher risk for CD was performed, immediately after the test but before knowing the test results. The 2 resulting groups were: (a) POCT positive and (b) symptomatic subject at CF. Subjects were defined as symptomatic at CF in the presence of 1 or more symptoms. All POCT-positive or symptomatic subjects at CF were referred to the CD Centers for confirmation of CD. Data on resource consumption were gathered from patients' charts. Cost of examinations, and diagnostic and laboratory tests were estimated with regional outpatient tariffs (Sicily), and a price of €2.5 was used for each POCT.Results: Of a total of 2197 subjects who agreed to participate in the study, 36 (1.6%) and 671 (30.5%) were POCT positive and symptomatic at CF, respectively. The yield from the screening and CF was 5 new celiac patients. The total cost and mean cost for each new CD case were €7497.35 and €1499.47 for the POCT screening strategy, and €9855.14 and €1971.03 for the CF strategy, respectively. Assuming consecutive use of both strategies, performing POCT only in symptomatic subjects at CF, the calculated yield would be 4 new diagnoses with a total cost of €2345.84 and a mean cost of €586.46 for each newly diagnosed patient. Only 1 patient was celiac despite a negative POCT. Conclusions:Testing symptomatic subjects at CF only by POCT seems the most cost-effective strategy to bridge the diagnostic gap of adult CD in primary care.

Determining whether coeliac disease case-finding in primary care is better than random testing: a retrospective study

“…There was a very recent study from Sicily that looked at two separate strategies for testing in primary care. 11 The first strategy involved serial testing of consecutive subjects aged <75 years being offered a point-of-care test (POCT) for coeliac disease. The second strategy involved offering only those with symptoms or associated conditions a POCT, but there was a systematic search for patients with this second strategy.…”

Updates on the diagnosis and management of celiac disease

“…One of the many studies in the past 5 years that analyzed the diagnostic yield of point-of-care tests found that the test for celiac disease has a sensitivity of 75% and a specificity of 99.2%, with a negative predictive value of 99.2% 6. The test uses IgA testing to interpret the patient's endogenous transglutaminase 2 (TG2) complexes found in the erythrocytes of whole blood by labeled antihuman IgA within 5 minutes 2.…”

“…The increased availability and quick result time makes this test appealing and its user-friendly design encourages clinicians to begin testing for celiac disease earlier in the disease. Ultimately, the IgA point-of-care test yields increased diagnostic rates for celiac disease, which reduces the likelihood of patients developing long-term complications from undiagnosed disease 6…”

Recognizing the Emergent and Submerged Iceberg of the Celiac Disease: ITAMA Project—Global Strategy Protocol

“…This paper has been partially supported by the ITAMA project under the international cooperation program INTERREG V-A (JS-Code C1-1. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The content of this publication does not reflect the official opinion of the European Union.…”

“…A case study in the Netherlands Youth Health Care Centres, using a POCT to assess TGA-IgA, highlighted the fact that untreated CD has a considerable health burden on society [13]. Moreover, a preceding study had suggested that a mass screening using POCTs may be a useful and economic option for screening asymptomatic children and seems more convenient than a case finding strategy based on symptoms [14], contrary to what is observed in adults [15]. A literature review [12] showed that a critical point for using a POCT as screening tool is to define, with very narrow confidence limits, the negative predictive values of a test validated in a prospective way and to determine the reference standard to all subjects to whom a test has to be applied.…”