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Cost effectiveness of mass screening for coeliac disease is determined by time‐delay to diagnosis and quality of life on a gluten‐free diet
Author(s) -
HERSHCOVICI T.,
LESHNO M.,
GOLDIN E.,
SHAMIR R.,
ISRAELI E.
Publication year - 2010
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2010.04242.x
Subject(s) - medicine , coeliac disease , quality adjusted life year , population , cost effectiveness , pediatrics , quality of life (healthcare) , disease , environmental health , risk analysis (engineering) , nursing
Aliment Pharmacol Ther 31 , 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.