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Endocrine Abstracts (2022) 86 P299 | DOI: 10.1530/endoabs.86.P299

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.

Volume 86

Society for Endocrinology BES 2022

Harrogate, United Kingdom
14 Nov 2022 - 16 Nov 2022

Society for Endocrinology 

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