Cost effectiveness of mass screening for coeliac disease is determined by time-delay to diagnosis and quality of life on a gluten-free diet

Authors


  • 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.

Dr E. Israeli, Gastroenterology Department, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel 91120.
E-mail: eran-i@bezeqint.net

Abstract

Aliment Pharmacol Ther31, 901–910

Summary

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.

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