Evaluating the Cost-effectiveness of Two Strategies for Early Detection of Celiac Disease in Children

Celiac.com 10/07/2024 - Celiac disease is a widespread autoimmune condition triggered by the consumption of gluten, a protein found in wheat, barley, and rye. Despite its prevalence, celiac disease remains significantly underdiagnosed, leading to long-term health issues for those affected. The only effective treatment is a strict gluten-free diet, which can be challenging to maintain. Diagnosing celiac disease early in life is crucial for preventing complications and improving the quality of life. However, the process of diagnosis is often delayed due to the disease's varied symptoms and the lack of widespread awareness.

The Importance of Early Detection

This study focuses on evaluating the cost-effectiveness of two strategies for early detection of celiac disease in children: active case finding and mass screening. Both strategies involve using point-of-care tests that can identify antibodies specific to celiac disease, allowing for earlier diagnosis and intervention. The study uses a decision tree and Markov model to simulate the long-term outcomes and costs associated with these strategies compared to the current standard of care in the Netherlands.

Cost-Effectiveness of Mass Screening and Case Finding

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The study found that mass screening and active case finding are both cost-effective methods for identifying celiac disease in children. Mass screening resulted in an additional 7.46 quality-adjusted life years (QALYs) per child, while case finding produced 4.33 more QALYs, compared to the current care model. Although these strategies are more expensive than the current practice, the cost per QALY gained is considered acceptable within the Netherlands' willingness-to-pay threshold.

Mass screening was slightly more effective than case finding, primarily because it detected more cases early, leading to better long-term health outcomes. However, it also incurred higher costs due to the broader implementation of the screening process. The study concluded that mass screening is likely the optimal strategy unless the benefit of detecting asymptomatic cases is minimal, in which case case finding might be preferable.

Long-Term Health and Economic Impacts

The earlier identification of celiac disease through these strategies can lead to significant improvements in health outcomes for affected children. By diagnosing the disease earlier, children can start a gluten-free diet sooner, which helps to alleviate symptoms, improve quality of life, and reduce the risk of long-term complications such as osteoporosis and certain cancers. Additionally, early detection can lead to cost savings in non-healthcare areas, such as reduced absenteeism from school or work and lower costs associated with managing the disease.

The study also highlighted the societal perspective, taking into account not only healthcare costs but also non-healthcare costs like productivity losses and the expenses of following a gluten-free diet. These costs are often overlooked in economic evaluations but represent a significant burden for individuals with celiac disease.

Scenario Analysis and Sensitivity Testing

The study's conclusions were robust across various sensitivity analyses, which tested different assumptions about the impact of detecting asymptomatic cases of celiac disease. Even under conservative assumptions, both mass screening and case finding were found to be cost-effective compared to the current standard of care. However, the relative advantage of mass screening over case finding depends on the benefits of detecting asymptomatic cases, which remains an area of uncertainty.

Conclusion: Significance for Those with Celiac Disease

This study provides strong evidence that early detection of celiac disease in children through mass screening or case finding is not only beneficial for health outcomes but also cost-effective in the long term. For individuals with celiac disease and their families, this research highlights the importance of early diagnosis and the potential for reducing the disease's overall burden. Implementing these screening strategies could lead to earlier treatment, better quality of life, and a reduction in long-term health risks, making a significant difference in the lives of those affected by celiac disease.

Read more at: gastrojournal.org