Economic benefits of increased diagnosis of celiac disease in a national managed care population in the United States

Celiac Disease Center, Columbia University College of Physicians and Surgeons, Harkness Pavilion, 180 Fort Washington, Suite 956, New York, NY 10032, USA.
Journal of insurance medicine (New York, N.Y.) 02/2008; 40(3-4):218-28.
Source: PubMed


To estimate the rate of celiac disease diagnosis and evaluate the economic benefits of diagnosis by analyzing retrospective cohorts from a national managed-care-population database.
We identified patients who received a new diagnosis of celiac disease. We also identified 3 control groups, persons without a diagnosis of celiac disease but who exhibited 1, 2, or 3 or more symptoms associated with the disease. Using claims, encounter, and eligibility data of approximately 10.2 million managed care members across the United States between January 1999 and December 2003, we measured and compared direct standardized relative value based (RVU) medical costs and utilization of selected health care services among the 4 study cohorts.
The rate of new diagnosis for celiac disease more than doubled over the 4-year period. The celiac disease cohort had a significant trend reduction in direct standardized medical costs relative to the three control groups. RVU-based medical costs in the celiac cohort were 24%, 33%, and 27% lower than cohort 1 (p<0.05), 29.0%, 38%, and 24% lower than cohort 2 (p<0.05), and 38%, 33%, and 31% lower than cohort 3 (p<0.01) for the 12-month, 24-month and 36-month post-diagnosis periods, respectively. The reductions in costs were attributable to decreasing trends in utilization of office visits, lab, diagnostic, imaging, and endoscopy procedures relative to the 3 comparative cohorts over the 3-year follow-up period.
There was an increase in the rate of celiac disease diagnosis, which was associated with significant reduction in direct standardized RVU-based medical costs and utilization of selected health care services over time.

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    • "Analysis from the United Kingdom shows that significant additional primary care costs are associated with CD [15]. Three studies, two American and one from the Mediterranean region have shown reduction in direct medical costs of selected services after diagnosis [13,16,17]. As a result of the increasing prevalence of CD, the public health burden of the disease makes it a possible candidate for universal screening [18-20]. "
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    ABSTRACT: The aim of this study was to identify costs in patients diagnosed with Celiac disease. This retrospective case control study covered the period 2003-2006 and was conducted in a large Israeli Health Maintenance Organization insuring over two million members. Our cohort comprised 1,754 patients with Celiac disease with a control group of 15,040. Costs were aggregated according to main cost-branches and computed individually for each member. A linear step wise regression was performed with costs being the dependent variable and the independent variables; age, gender and the presence of celiac disease. Costs were compared with patients suffering from other chronic diseases. The total costs of the patients with celiac disease were significantly higher than that of the control group for hospital admission, medications, laboratory and imaging. Hospital admission rate was 7.98% as opposed to 7.1% for the control group (p = 0.06). When compared with other chronic illnesses, the costs of patients with celiac disease were similar to those of patients with diabetes and hypertension. Patients with Celiac disease utilize medical services more than the general population. This research suggests that the use of medical resources by patients with Celiac disease may be higher than previously thought.
    11/2013; 3(1):23. DOI:10.1186/2191-1991-3-23
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    • "Two recent retrospective studies from the USA found that treatment with a gluten-free diet resulted in decreased medical costs due to reduced use of health care services among coeliac disease patients. However, these studies concentrated on direct costs and obtained study participants in high-volume referral centres or administrative claim registers [23,24], which may limit extrapolation of the data to the whole coeliac disease population. It is of note that the main findings - excessive health care service use before the diagnosis of coeliac disease and reduction in the consumption of these services during a gluten-free diet - were in line, despite the difference in settings between these earlier trials and our current prospective nation-wide study. "
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    ABSTRACT: Approximately 1% of the population suffer from coeliac disease. However, the disease is heavily underdiagnosed. Unexplained symptoms may lead to incremented medical consultations and productivity losses. The aim here was to estimate the possible concealed burden of untreated coeliac disease and the effects of a gluten-free diet. A nationwide cohort of 700 newly detected adult coeliac patients were prospectively evaluated. Health care service use and sickness absence from work during the year before diagnosis were compared with those in the general population; the data obtained from an earlier study. Additionally, the effect of one year on dietary treatment on the aforementioned parameters and on consumption of pharmaceutical agents was assessed. Untreated coeliac patients used primary health care services more frequently than the general population. On a gluten-free diet, visits to primary care decreased significantly from a mean 3.6 to 2.3. The consumption of medicines for dyspepsia (from 3.7 to 2.4 pills/month) and painkillers (6.8-5.5 pills/month) and the number of antibiotic courses (0.6-0.5 prescriptions/year) was reduced. There were no changes in hospitalizations, outpatient visits to secondary and tertiary care, use of other medical services, or sickness absence, but the consumption of nutritional supplements increased on treatment. Coeliac disease was associated with excessive health care service use and consumption of drugs before diagnosis. Dietary treatment resulted in a diminished burden to the health care system and lower use of on-demand medicines and antibiotic treatment. The results support an augmented diagnostic approach to reduce underdiagnosis of coeliac disease. Trial registration NCT01145287
    BMC Gastroenterology 09/2012; 12(1):136. DOI:10.1186/1471-230X-12-136 · 2.37 Impact Factor
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    • "It has been shown, however, that the cost of food for CD patients is higher than for non-CD persons [6], and that women with CD consume more health care than other women [7]. CD diagnosis and treatment has also been shown to decrease the costs for medical care in the United States, suggesting that a diagnosis can convey economic savings for society [8,9]. There is an association between CD and other immune-mediated diseases, with CD being more prevalent among diabetes mellitus type 1 and thyroid disease patients [10-12] and inflammatory bowel disease and thyroid disease being more prevalent among CD patients [13-15]. "
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    ABSTRACT: Background A gluten-free diet is the only available treatment for celiac disease. Our aim was to investigate the effect of a gluten-free diet on celiac disease related symptoms, health care consumption, and the risk of developing associated immune-mediated diseases. Methods A questionnaire was sent to 1,560 randomly selected members of the Swedish Society for Coeliacs, divided into equal-sized age- and sex strata; 1,031 (66%) responded. Self-reported symptoms, health care consumption (measured by health care visits and hospitalization days), and missed working days were reported both for the year prior to diagnosis (normal diet) and the year prior to receiving the questionnaire while undergoing treatment with a gluten-free diet. Associated immune-mediated diseases (diabetes mellitus type 1, rheumatic disease, thyroid disease, vitiligo, alopecia areata and inflammatory bowel disease) were self-reported including the year of diagnosis. Results All investigated symptoms except joint pain improved after diagnosis and initiated gluten-free diet. Both health care consumption and missed working days decreased. Associated immune-mediated diseases were diagnosed equally often before and after celiac disease diagnosis. Conclusions Initiated treatment with a gluten-free diet improves the situation for celiac disease patients in terms of reduced symptoms and health care consumption. An earlier celiac disease diagnosis is therefore of great importance.
    BMC Gastroenterology 09/2012; 12(1):125. DOI:10.1186/1471-230X-12-125 · 2.37 Impact Factor
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