title: Cost-effective strategy for the serological investigation of coeliac disease.
abstract: Increased numbers of requests for serological investigation of coeliac disease, and a local trend to request both anti-gliadin antibodies (AGA) and anti-endomysium antibodies (AEA) simultaneously, resulted in cost pressures that prompted a review of our practice. Serology results from all patients (771 children, 511 adults) investigated for coeliac disease over a 3-year period were compared with small intestine histology where available. IgG AGA and IgA AGA were measured by enzyme-linked immunosorbent assay (in-house), IgA AEA by immunofluorescence (send-away contract). Overall diagnostic performance was as follows: AGA sensitivity 84%, specificity 88%, positive predictive value (PPV) 24%, negative predictive value (NPV) 99%; AEA sensitivity 88%, specificity 97%, PPV 65%, NPV 99%. Results showed AGA, with its high NPV, to be a suitable first-line test to exclude coeliac disease. The high specificity of AEA makes it a suitable confirmatory test when AGA is positive. Introduction of this step-wise approach to coeliac disease investigation resulted in cost savings of at least Pound Sterling 5000 per year without detriment to the clinical service.
authors.affiliation: Department of Chemical Pathology, Bristol Royal Infirmary, UK. Ann.Bowron@ubht.swest.nhs.uk
authors.forename: A
authors.initials: A
authors.lastname: Bowron
authors.forename: M
authors.initials: M
authors.lastname: Moorghen
authors.forename: J E
authors.initials: JE
authors.lastname: Morgan
authors.forename: J R
authors.initials: JR
authors.lastname: Osborne
authors.forename: D
authors.initials: D
authors.lastname: Stansbie
authors.forename: J E
authors.initials: JE
authors.lastname: Stone
mesh_terms: D000293:Adolescent; D000328:Adult; D000906:Antibodies / Q000378:metabolism; D002446:Celiac Disease / Q000097:blood* / Q000175:diagnosis*; D002624:Chemistry, Clinical / Q000191:economics* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005455:Fluorescent Antibody Technique; D005903:Gliadin / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D007421:Intestine, Small / Q000473:pathology; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000276:immunology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D000906:Antibodies; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005903:Gliadin