Esophagus to Small Intestine
Gastroenterology. 2024;167(6):1129-1140
Long-term cost-effectiveness of case finding and mass screening for celiac disease in children
Background and aims: Celiac disease (CD) is a common yet underdiagnosed autoimmune disease with substantial long-term consequences. High-accuracy point-of-care tests for CD antibodies conducted at youth primary health care centers may enable earlier identification of CD, but evidence about the cost-effectiveness of such strategies is lacking. The authors estimated the long-term cost-effectiveness of active case finding and mass screening compared with clinical detection in the Netherlands.
Methods: A decision tree and Markov model were used to simulate a cohort of 3-year-old children with CD according to each strategy, taking into account their impact on long-term costs (from a societal perspective) and quality-adjusted life-years (QALYs). Model parameters incorporated data from the GLUTENSCREEN project, the Dutch Celiac Society, the Dutch Pediatric Surveillance Unit, and published sources. The primary outcome was the incremental cost-effectiveness ratio (ICER) between strategies.
Results: Mass screening produced 7.46 more QALYs and was € 28,635 more costly compared with current care (ICER: € 3841 per QALY), and case finding produced 4.33 more QALYs and was € 15,585 more costly compared with current care (ICER: € 3603 per QALY). At a willingness to pay of € 20,000 per QALY, both strategies were highly cost-effective compared with current care. Scenario analyses indicated that mass screening is likely the optimal strategy, unless no benefit in detecting asymptomatic cases is assumed.
Conclusions: An earlier identification of celiac disease through screening or case finding in children using a point-of-care test leads to improved health outcomes and is cost-effective in the long-term compared with current care. If the feasibility and acceptability of the proposed strategies are successful, implementation in Dutch regular care is needed.