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

Norström, Fredrik ; Myléus, Anna ; Nordyke, Katrina ; Carlsson, Annelie LU orcid ; Högberg, Lotta ; Sandström, Olof ; Stenhammar, Lars ; Ivarsson, Anneli and Lindholm, Lars (2021) In BMC Gastroenterology 21(1).
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... (More)

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.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adolescent, Coeliac disease, Compliance, Cost-effectiveness, Long delay, QALY, Screening
in
BMC Gastroenterology
volume
21
issue
1
article number
159
publisher
BioMed Central (BMC)
external identifiers
  • pmid:33836647
  • scopus:85104144094
ISSN
1471-230X
DOI
10.1186/s12876-021-01737-1
language
English
LU publication?
yes
id
e5582dc2-3c6a-44e5-b96e-bb342d6af3d9
date added to LUP
2021-04-26 08:05:46
date last changed
2024-05-19 07:41:11
@article{e5582dc2-3c6a-44e5-b96e-bb342d6af3d9,
  abstract     = {{<p>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.</p>}},
  author       = {{Norström, Fredrik and Myléus, Anna and Nordyke, Katrina and Carlsson, Annelie and Högberg, Lotta and Sandström, Olof and Stenhammar, Lars and Ivarsson, Anneli and Lindholm, Lars}},
  issn         = {{1471-230X}},
  keywords     = {{Adolescent; Coeliac disease; Compliance; Cost-effectiveness; Long delay; QALY; Screening}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Gastroenterology}},
  title        = {{Is mass screening for coeliac disease a wise use of resources? A health economic evaluation}},
  url          = {{http://dx.doi.org/10.1186/s12876-021-01737-1}},
  doi          = {{10.1186/s12876-021-01737-1}},
  volume       = {{21}},
  year         = {{2021}},
}