Tiberiu Hershcovici and Moshe Leshno contributed equally to the manuscript and share first authorship. Raanan Shamir and Eran Israeli contributed equally to the manuscript and share last authorship.
Cost effectiveness of mass screening for coeliac disease is determined by time-delay to diagnosis and quality of life on a gluten-free diet
Article first published online: 19 JAN 2010
© 2010 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 31, Issue 8, pages 901–910, April 2010
How to Cite
HERSHCOVICI, T., LESHNO, M., GOLDIN, E., SHAMIR, R. and ISRAELI, E. (2010), Cost effectiveness of mass screening for coeliac disease is determined by time-delay to diagnosis and quality of life on a gluten-free diet. Alimentary Pharmacology & Therapeutics, 31: 901–910. doi: 10.1111/j.1365-2036.2010.04242.x
- Issue published online: 17 MAR 2010
- Article first published online: 19 JAN 2010
- Publication data Submitted 21 August 2009 First decision 15 September 2009 Resubmitted 15 January 2010 Accepted 16 January 2010 Epub Accepted Article 19 January 2010
Aliment Pharmacol Ther 31, 901–910
Background Coeliac disease is frequently diagnosed after a long delay resulting in increased morbidity and mortality.
Aims To define the parameters which have the highest impact on the cost-effectiveness of mass screening for coeliac disease.
Methods A Markov model examined a coeliac disease screening programme of the healthy young-adult general population compared with a no-screening strategy. The main outcome measures were quality adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER). Effects of variables were examined using sensitivity analyses.
Results The screening strategy resulted in a gain of 0.0027 QALYs. The ICER of screening vs. no-screening strategy was US$48 960/QALYs. The variables with the largest impact on cost effectiveness were: the time delay from symptom onset to diagnosis, the utility of adherence to a gluten-free diet (GFD) and the prevalence of coeliac disease. Screening would be cost-effective if the time delay to diagnosis is longer than 6 years and utility of GFD adherence is greater than 0.978.
Conclusions Our model suggests that mass screening for coeliac disease of the young-adult general population is associated with improved QALYs and is a cost effectiveness strategy. Shortening of the time-delay to diagnosis by heightened awareness of health-care professionals may be a valid alternative to screening.