Celiac Disease Mass Screening May be Cost Effective

Celiac.com 04/21/2010 - Due to the overwhelming number of ways celiac disease can manifest, it is often misdiagnosed by health care professionals. Celiac disease is also commonly diagnosed later in life, resulting in an  increase in celiac patient's morbidity and mortality. As such, it has been suggested that early screening of celiac disease is an effective way to eliminate misdiagnosis, and  can also minimize symptoms and complications that often manifest as a result of misdiagnosed or undiagnosed celiac disease. 

To determine the cost effectiveness of early screening for celiac disease, a group of researchers at the Hadassah-Hebrew University Medical Center, Jerusalem developed a state transition Markov model using information that was collected from previous studies of celiac. The model they used, was geared toward defining the parameters that have the greatest impact on the cost-effectiveness of mass screening for celiac disease. The Markov model examined a celiac disease screening program of  healthy young-adults in the general population compared with no-screening.

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The results of the study indicated  a gain of 0.0027 quality-adjusted life years (QALY). The cost effectiveness ratio of screening the young adults, versus no screening for celiac at all was $48,000 per QALY. The variables that had the greatest impact on cost-effectiveness were, the time delay from symptom onset to diagnosis, the strict adherence to a gluten-free diet, and the generality of celiac disease.

This study determined that celiac screening would be cost effective if the time delay to diagnose is longer than 6 years, and adherence to a gluten-free diet is greater than 0.978.  Additionally, the Markov model indicates that mass screening for celiac disease among the young adult general population is associated with improved QALY's and is also a cost effective strategy. However, the authors of the study also state  that shortening the time-delay to diagnosis through heightened education and awareness of health-care professionals, may be a legitimate alternative to celiac screening in general.

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