Department of Clinical Biochemistry, Virgen del Rocío University Hospital, Seville, Spain.
Clin Chim Acta. 2011 Nov 20;412(23-24):2248-53. doi: 10.1016/j.cca.2011.08.013. Epub 2011 Aug 16.
A single midnight serum cortisol (MSC) test has been reported to possess the best sensitivity and specificity for diagnosing Cushing's syndrome (CS). However, this test requires patient hospitalization, making it costly. This paper aims to compare the hospital budget impact and accuracy of using midnight salivary cortisol (MSVC), as opposed to MSC, in the diagnosis of hypercortisolism.
77 patients with at least two high urinary free cortisol (UFC) values (>360 nmol/24 h) were selected from 611 patients with clinical symptoms of CS. The costs of the method to confirm the diagnosis of hypercortisolism was calculated comparing Option A using MSC (UFCx2, low-dose dexamethasone suppression test [LDDST]) that requires patient hospitalization versus Option B using MSVC (UFCx2, LDDST) in which the evaluation is done outside the Hospital. A budget impact analysis for one year was developed, and a sensitivity analysis in different scenarios was performed. Reproducibility and diagnostic performance of MSVC and MSC were also measured.
Salivary cortisol is a sound analytical method for evaluating free serum cortisol due to its classification accuracy, good imprecision, linearity, and stability. AUC(ROC) comparison between MSVC and MSC shows no significant differences. The substitution of the MSC for MSVC in our hospital could save between €16,762 and €132,804 in one year.
The use of MSVC in the diagnosis of hypercortisolism can result in a substantial decrease in the budget impact, without losing diagnosis accuracy and reliability, a significant advantage considering the current emphasis on reducing the financial burden of health care.
有研究报道，单次午夜血清皮质醇（MSC）检测在诊断库欣综合征（CS）方面具有最佳的灵敏度和特异性。然而，这种检测需要患者住院，因此成本较高。本文旨在比较使用午夜唾液皮质醇（MSVC）与 MSC 诊断皮质醇增多症的医院预算影响和准确性。
从 611 例有 CS 临床症状的患者中选择了 77 例至少有两次高尿游离皮质醇（UFC）值（>360 nmol/24 h）的患者。通过比较选项 A（使用 MSC（UFCx2，小剂量地塞米松抑制试验 [LDDST]）需要患者住院）和选项 B（使用 MSVC（UFCx2，LDDST），在医院外进行评估）来确认皮质醇增多症诊断的方法的成本，计算出确认诊断的成本。对一年的预算影响进行了分析，并在不同情况下进行了敏感性分析。还测量了 MSVC 和 MSC 的重现性和诊断性能。
唾液皮质醇是一种评估血清游离皮质醇的可靠分析方法，因其分类准确性、良好的不精密度、线性和稳定性而得到认可。MSVC 和 MSC 的 AUC（ROC）比较无显著差异。在我们的医院中，用 MSVC 替代 MSC 可以在一年内节省 16762 至 132804 欧元。
在诊断皮质醇增多症时使用 MSVC 可以显著降低预算影响，同时不会降低诊断的准确性和可靠性，这在当前强调减轻医疗保健财务负担的情况下具有重要意义。
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