EVALUATION OF THE ENDOMYSIAL ANTIBODY FOR CELIAC-DISEASE - OPERATING PROPERTIES AND ASSOCIATED COST IMPLICATIONS IN CLINICAL-PRACTICE

OBJECTIVE: To evaluate the operating properties of endomysial antibodi es (EMAs) in the diagnosis of celiac disease and to examine, using a c ost minimization model, different strategies used in the diagnosis of celiac disease. METHODS: A total of 248 EMA results were reviewed and compared with small bowel biopsy results in 66 patients who had underg one both tests. Regression analysis was used to look for predictors of positive EMA results and positive biopsy results. A cost minimization model from a societal perspective was used to evaluate the cost diffe rences among three different strategies. RESULTS: EMAs had a sensitivi ty of 95% and specificity of 64%. The only predictor of a positive bio psy result that reached statistical significance:was a positive EMA. T he strategy of EMA as a diagnostic test for celiac disease was the mos t expensive strategy, with a cost of $3,174 per patient assessed. The strategy of small bowel biopsy for all patients had a cost of $997, an d a strategy of EMA followed by small bowel biopsy for positive patien ts had a cost of $866 per patient. The results were sensitive to cost Of a gluten-free diet, the specificity of the EMA and the cost of a sm all bowel biopsy. CONCLUSION: The EMA is best used as a screening test from both a clinical and cost perspective.