SFEBES2022 Poster Presentations Adrenal and Cardiovascular (66 abstracts)
Screening for adrenal insufficiency using home waking salivary cortisone is accurate and lowers NHS costs
Miguel Debono 1,2 , Charlotte Elder 2 , Jen Lewis 3 , Richard Jacques 3 , Sharon Caunt 1 , Jane Fearnside 3 , Simon Dixon 3 , John Newell-Price 2 , Martin Whitaker 2 , Brian Keevil 4 & Richard Ross 2
1Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; 2Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom; 3ScHaRR, University of Sheffield, Sheffield, United Kingdom; 4Manchester University NHS Foundation Trust, Manchester, United Kingdom
Introduction: The 250µg Short Synacthen test (SST) is the reference standard for a diagnosis of adrenal insufficiency (AI) in most endocrine centres. The test is expensive and time consuming, requiring clinic attendance. We hypothesised that a cheaper home waking salivary cortisone (WSC) is predictive of the SST 30-minute cortisol >430 nmol/l cut-off and carried out a diagnostic accuracy study to assess the predictive value of the WSC in diagnosing and excluding AI. We then carried out a cost analysis to compare two diagnostic strategies: the SST vs a two stage WSC±SST.
Methods: We recruited 220 patients prospectively and all patients collected a WSC (measured by LC-MS/MS) and a SST was carried out on the same day. Using ROC curves we computed diagnostic accuracy and then estimated Positive (PPV) and Negative Predictive Value (NPV). A decision analytic model was developed to describe the costs and outcomes associated with the SST vs WSC±SST. To obtain a societal perspective we also enquired about patient costs and time off work via questionnaire.
Results: The WSC was a strong predictor of the SST 30-minute serum cortisol >430 nmol/L: AuROC (95% CI), 95% (92,97%). Using a cut-off of ≥17 nmol/l one could exclude AI with a NPV 96% (90%,99%) and using a cut-off of <7 nmol/l one could confirm AI with a PPV 95% (87%,99%). Based on these values, using the WSC as a screening test would obviate the need for an SST in 70% of subjects. The economic results for the primary analysis show that a two-stage diagnostic strategy would save £102.83 in costs per patient. When using a societal perspective this strategy costs £126.99 less than current SST testing.
Conclusions: WSC is an accurate screening tool for AI and significantly reduces costs for the NHS. Home WSC should be introduced to clinical care.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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