Is mass screening for coeliac disease a wise use of resources? A health economic evaluation

Abstract

Background Living with undiagnosed symptomatic coeliac disease is connected with deteriorated health, and persons with coeliac disease often wait a long time for their diagnosis. A mass screening would lower the delay, but its cost-effectiveness is still unclear. Our aim was to determine the cost-effectiveness of a coeliac disease mass screening at 12 years of age, taking a life course perspective on future benefits and drawbacks. Methods The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model. As a basis for our assumptions, we mainly used information from the Exploring the Iceberg of Celiacs in Sweden (ETICS) study, a school-based screening conducted in 2005/2006 and 2009/2010, where 13,279 12-year-old children participated and 240 were diagnosed with coeliac disease, and a study involving members of the Swedish Coeliac Association with 1031 adult participants. Results The cost for coeliac disease screening was 40,105 Euro per gained QALY. Sensitivity analyses support screening based on high compliance to a gluten-free diet, rapid progression from symptom-free coeliac disease to coeliac disease with symptoms, long delay from celiac disease with symptoms to diagnosis, and a low QALY score for undiagnosed coeliac disease cases. Conclusions A coeliac disease mass screening is cost-effective based on the commonly used threshold of 50,000 Euro per gained QALY. However, this is based on many assumptions, especially regarding the natural history of coeliac disease and the effects on long-term health for individuals with coeliac disease still eating gluten.

Five-year follow-up of new cases after a coeliac disease mass screening

“…In a recently published health economic evaluation, we showed that coeliac disease screening of children aged 12 years can be considered cost effective, especially if the children diagnosed adhere to a gluten-free diet. 20 Of the children in the second phase of the screening, 69% reported to be always gluten free and 25% often gluten free at the 5-year follow-up. 21 Corresponding numbers for the first phase were 56% and 29% for always gluten free and often gluten free, respectively (unpublished data).…”

“…Applying these guidelines to the follow-up, one child could have been diagnosed without the biopsy. In a recently published health economic evaluation, we showed that coeliac disease screening of children aged 12 years can be considered cost effective, especially if the children diagnosed adhere to a gluten-free diet 20. Of the children in the second phase of the screening, 69% reported to be always gluten free and 25% often gluten free at the 5-year follow-up 21.…”

Population level screening for celiac disease: is now the time?

“…Several factors must be addressed before celiac disease mass screening can be seriously considered. First, while several studies suggest that mass screening is cost effective, more studies are needed that represent cost effectiveness throughout the lifespan and worldwide, and the impact on society such as work productivity [44][45][46]. These studies must also address how mass screening compares to the expense and benefit derived from current targeted screening approaches.…”

Population-Based Screening for Coeliac Disease in Lithuanian Children from 2009 to 2014

“…Secondly, the quick fingertip point-of-care test presents a convenient, feasible, and precise approach for screening coeliac disease in a diverse pediatric population. Easily implemented, cost-effective methods for coeliac disease diagnostics could play an important part in mass-screening and gathering epidemiological data [ 16 , 17 ].…”