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.
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.
Authors: Jonas F Ludvigsson; Timothy R Card; Katri Kaukinen; Julio Bai; Fabiana Zingone; David S Sanders; Joseph A Murray Journal: United European Gastroenterol J Date: 2015-04 Impact factor: 4.623
Authors: Edwin Liu; Fran Dong; Anna E Barón; Iman Taki; Jill M Norris; Brigitte I Frohnert; Edward J Hoffenberg; Marian Rewers Journal: Gastroenterology Date: 2017-02-07 Impact factor: 22.682
Authors: K H Long; A Rubio-Tapia; A E Wagie; L J Melton; B D Lahr; C T Van Dyke; J A Murray Journal: Aliment Pharmacol Ther Date: 2010-04-08 Impact factor: 8.171
Authors: K T Park; Raymond Tsai; Louise Wang; Nasim Khavari; Laura Bachrach; Dorsey Bass Journal: Clin Gastroenterol Hepatol Date: 2013-01-26 Impact factor: 11.382
Authors: Benjamin Lebwohl; Govind Bhagat; Sarah Markoff; Suzanne K Lewis; Scott Smukalla; Alfred I Neugut; Peter H R Green Journal: Dig Dis Sci Date: 2013-01-30 Impact factor: 3.199
Authors: Leyla Mohseninejad; Talitha Feenstra; Henriëtte E van der Horst; Hèlen Woutersen-Koch; Erik Buskens Journal: Eur J Health Econ Date: 2012-11-18
Authors: Benjamin Lebwohl; Alberto Rubio-Tapia; Asaad Assiri; Catherine Newland; Stefano Guandalini Journal: Gastrointest Endosc Clin N Am Date: 2012-08-20