Sicilian Celiac Disease Study Group.
Department of Biomedical and Dental Sciences and Morphofunctional Imaging.
J Clin Gastroenterol. 2019 Jan;53(1):15-22. doi: 10.1097/MCG.0000000000000962.
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.
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 &OV0556;2.5 was used for each POCT.
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 &OV0556;7497.35 and &OV0556;1499.47 for the POCT screening strategy, and &OV0556;9855.14 and &OV0556;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 &OV0556;2345.84 and a mean cost of &OV0556;586.46 for each newly diagnosed patient. Only 1 patient was celiac despite a negative POCT.
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.
比较 2 种策略（无论症状如何进行筛查与病例发现（CF））的诊断效果和成本后果，使用即时检测（POCT）在初级保健中检测乳糜泻（CD），以弥合成人 CD 的诊断差距。
所有 75 岁以下连续前往全科医生办公室的受试者均接受抗转谷氨酰胺酶免疫球蛋白 A 抗体的 POCT。所有同意进行 POCT 的受试者均进行了 POCT，然后立即在进行测试后但在了解测试结果之前，对与 CD 风险较高相关的症状或情况进行系统搜索。由此产生了 2 个组：（a）POCT 阳性和（b）CF 时出现症状的受试者。在存在 1 种或多种症状的情况下，将受试者定义为 CF 时出现症状。所有 POCT 阳性或 CF 时出现症状的受试者均被转诊至 CD 中心以确认 CD。从患者图表中收集了资源消耗数据。检查、诊断和实验室测试的费用均采用西西里岛的门诊收费标准进行估算，每个 POCT 的费用为 2.5 欧元。
在总共同意参加研究的 2197 名受试者中，分别有 36 名（1.6%）和 671 名（30.5%）POCT 阳性和 CF 时出现症状。筛查和 CF 的检出率为 5 例新的乳糜泻患者。POCT 筛查策略下每个新 CD 病例的总成本和平均成本分别为 7497.35 欧元和 1499.47 欧元，CF 策略下分别为 9855.14 欧元和 1971.03 欧元。假设连续使用这两种策略，仅在 CF 时出现症状的受试者中进行 POCT，则计算得出的检出率为 4 例新诊断，总成本为 2345.84 欧元，每个新诊断患者的平均成本为 586.46 欧元。尽管 POCT 结果为阴性，但只有 1 名患者患有乳糜泻。
仅通过 CF 对出现症状的受试者进行 POCT 检测似乎是在初级保健中弥合成人 CD 诊断差距的最具成本效益的策略。
