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Long-Term Cost-Effectiveness of Case Finding and Mass Screening for Celiac Disease in Children

Jan Heijdra Suasnabar1, Caroline R Meijer2, Lucy Smit3

  • 1Department of Biomedical Data Science, Leiden University Medical Centre, Leiden, the Netherlands.

Gastroenterology
|July 31, 2024
PubMed

Insights

Early detection of celiac disease (CD) in children through point-of-care testing is cost-effective. Both mass screening and case finding strategies improve health outcomes compared to current care, with mass screening potentially being optimal.

Area of Science:

  • Pediatric autoimmune diseases
  • Public health strategies
  • Health economics

Background:

  • Celiac disease (CD) is a common autoimmune disorder often diagnosed late.
  • Point-of-care tests for CD antibodies could facilitate early detection in primary care.
  • Evidence on the cost-effectiveness of early CD detection strategies is limited.

Purpose of the Study:

  • To estimate the long-term cost-effectiveness of active case finding and mass screening for CD in children compared to current clinical detection methods in the Netherlands.

Main Methods:

  • A decision tree and Markov model simulated a cohort of 3-year-old children.
  • The model assessed long-term costs (societal perspective) and quality-adjusted life-years (QALYs).
  • Data were sourced from the GLUTENSCREEN project, Dutch Celiac Society, and published literature.

Main Results:

  • Mass screening yielded 7.46 more QALYs at an additional cost of €28,635 (ICER: €3841/QALY).
  • Case finding yielded 4.33 more QALYs at an additional cost of €15,585 (ICER: €3603/QALY).
  • Both strategies were highly cost-effective at a willingness to pay of €20,000/QALY; mass screening is likely optimal.

Conclusions:

  • Early identification of CD in children via point-of-care testing improves health outcomes and is cost-effective long-term.
  • Implementation of these strategies in Dutch healthcare is recommended if feasible and acceptable.
  • Earlier diagnosis through screening or case finding offers significant benefits over current care.
Abstract

Keywords:
Case FindingCeliac DiseaseChildrenPoint-of-Care TestScreening

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