Celiac disease associated with significant economic burden

WASHINGTON — Patients with celiac disease incurred higher all-cause direct costs compared with non-celiac patients, especially those with uncontrolled celiac disease, according to data presented Digestive Disease Week.

“There have been few previous studies evaluating the cost burden associated with celiac disease,” Stefano Guandalini, MD, from the University of Chicago Celiac Center, said in a presentation. “Clearly, studies are needed to assess health care costs among patients with controlled and uncontrolled celiac disease … to better understand what factors drive excess costs.”

Stefano Guandalini

As the economic burden of celiac disease is unknown, Guandalini and colleagues performed a retrospective study using an administrative claims database with records of 18 million people in the U.S. from 1998 through 2013 to estimate the excess direct costs in patients with celiac disease compared with patients without celiac disease. Patients had continuous enrollment from baseline (1 year before index date) and through the study period (1 year after index date). Patients were characterized as having uncontrolled celiac disease if they had more than one celiac disease-related hospitalization, ED visit, outpatient visit or dietician visit during the study period. The researchers calculated total all-cause direct costs, including medical and prescription drug claims, and direct costs associated with celiac disease, which included medical claims only.

They identified 12,187 patients with celiac disease (83.6% controlled) and matched them to an equal number of controls based on sex, region, age, index date, company and employment status (mean age, 39.2 ± 17.9 years; 33.7% male). Patients with celiac disease had $12,217 total all-cause direct costs compared with $4,935 in controls (P < .0001). Patients with controlled celiac disease had a mean of $11,038 total all-cause direct costs and a mean of $686 celiac disease-related direct costs compared with $18,206 and $4,189, respectively, in uncontrolled patients. Medical costs were $8,723 and $15,499 for controlled and uncontrolled celiac patients, respectively, which accounted for the majority of all-cause total costs, including hospitalizations ($1,963 and $6,906, respectively) and outpatient visits ($6,456 and $7,785, respectively).

The researchers concluded that patients with celiac disease had 2.5 times the total all-cause direct costs of matched controls, patients with uncontrolled celiac disease had 2.8 times the total all-cause direct costs of matched controls, and patients with uncontrolled celiac disease had more than six times higher celiac disease-related costs compared with patients with controlled celiac disease.

“Patients with celiac disease, and especially uncontrolled celiac disease, incurred significantly higher total all-cause direct costs … compared with matched controls,” Guandalini said. “In addition, uncontrolled patients had celiac disease-related costs that were more than six times higher than those of controlled celiac disease patients. The likely reason for the higher direct costs is the increased presence of comorbidities.”– by Adam Leitenberger

For more information:

Guandalini S, et al. Abstract 2. Presented at: Digestive Disease Week, May 16-19, 2015; Washington, D.C.

Disclosure: Guandalini reports he is a consultant for AbbVie. Please see the DDW faculty disclosure index for all other researchers’ relevant financial disclosures.