Serologic testing for celiac disease in young adults--a cost-effect analysis

Healthcare systems increasingly face pressure to balance diagnostic accuracy with financial constraints. Celiac disease diagnosis has seen rising costs due to expanded screening in young adults. Prior research has shown that serologic tests like tTG and EMA can detect celiac disease. However, no prior work had resolved how best to allocate these tests in high- and low-risk subgroups. This gap motivated an analysis of diagnostic efficiency. The military population offers a unique setting for such studies. No prior work had resolved how to optimize screening in this group. Traditional approaches may not account for subgroup risk levels. This paper's contribution lies in evaluating cost-effectiveness across clinical risk categories.

The aim of this study was to assess the cost-effectiveness of serologic testing for celiac disease in young adults. The specific problem addressed is the rising diagnostic expenditures in military populations. The motivation stems from the need to balance diagnostic accuracy with fiscal responsibility. The researchers propose a risk-based screening approach. They suggest that diagnostic protocols should adapt to clinical presentation. The study focuses on two subgroups: low-risk and high-risk. The goal is to minimize costs while preserving diagnostic quality. This approach could inform broader healthcare screening strategies.

The study population included 538 military personnel suspected of celiac disease. Participants were divided into low-risk and high-risk subgroups based on clinical symptoms. Serologic tests evaluated included tTG, EMA, and AGA IgG. Sensitivity and specificity of these markers were calculated. Cost-effect ratios were determined as cost per diagnosed case. Cost minimization was measured as cost per screened individual. A two-step screening protocol was tested for high-risk subjects. A one-step follow-up was proposed for low-risk subjects.

Eight new celiac disease cases were diagnosed among the 538 tested. All eight cases belonged to the high-risk subgroup. These patients had at least two positive serologic tests. EMA antibodies showed the highest sensitivity and specificity. Average screening expenditure was $287 per patient. The lowest cost-effect ratio was achieved with a two-step protocol. High-risk subjects underwent EMA testing first. Low-risk subjects required only a single-step follow-up. This approach reduced diagnostic costs without compromising accuracy.

The authors propose that diagnostic protocols should adapt to subgroup risk levels. They suggest that high-risk individuals benefit from EMA testing followed by biopsy if positive. Low-risk individuals may require only clinical follow-up. This approach minimizes costs while preserving diagnostic quality. The study supports selective diagnostic workups in young adults. The findings suggest that a two-step protocol is most efficient. The authors state that this method reduces unnecessary expenditures. They emphasize the importance of risk-based screening in military populations.