Article

Cost-Effectiveness of Universal Serological Screening to Prevent Non-Traumatic Hip and Vertebral Fractures in Patients with Celiac Disease.

Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford University
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association (Impact Factor: 6.53). 01/2013; 11(6). DOI: 10.1016/j.cgh.2012.12.037
Source: PubMed

ABSTRACT BACKGROUND & AIMS: Patients with asymptomatic or poorly managed celiac disease can experience bone loss, placing them at risk for hip and vertebral fractures. We analyzed the cost-effectiveness of universal serologic screening (USS) vs symptomatic at-risk screening (SAS) strategies for celiac disease, given the risk of non-traumatic hip and vertebral fractures if untreated or undiagnosed. METHOD: We developed a lifetime Markov model of the screening strategies, each with male or female cohorts of 1000 patients, 12 years old when screening began. We screened serum samples for levels of immunoglobulin A (IgA), compared with tissue transglutaminase and total IgA, and findings were confirmed by mucosal biopsy. Transition probabilities and quality of life estimates were obtained from the literature. We used generalizable cost estimates and Medicare reimbursement rates, and ran deterministic and probabilistic sensitivity analyses. RESULT: For men, the average life-time costs were $8532 and $8472 for USS and SAS strategies, respectively, corresponding to average quality adjusted life years (QALY) gains of 25.511 and 25.515. Similarly, for women, costs were $11,383 and $11,328 for USS and SAS strategies, corresponding to QALY gains of 25.74 and 25.75. Compared to the current standard of care (SAS), USS produced higher average lifetime costs and lower quality of life for each sex. Deterministic and probabilistic sensitivity analyses showed that the model was robust to realistic changes in all the variables, making USS cost ineffective, based on these outcomes. CONCLUSION: USS and SAS are similar in lifetime costs and quality of life, although the current SAS strategy was overall more cost effective in preventing bone loss and fractures among patients with undiagnosed or subclinical disease. Based on best available supportive evidence, it is more cost effective to maintain the standard celiac screening practices, although future robust population-based evidence in other health outcomes could be leveraged to re-evaluate current screening guidelines.

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