Mass screening for celiac disease in children ‘highly cost effective’ vs standard care
Click Here to Manage Email Alerts
Key takeaways:
- Earlier detection of celiac disease in young children through mass screening and active case-finding was more cost effective vs. current care.
- Using point-of-care testing also led to long-term health outcomes.
Earlier detection of celiac disease in children through mass screening or case-finding was “highly cost-effective” and improved long-term health outcomes vs. current practices, according to a study conducted in the Netherlands.
“Advancements in diagnostic tools, such as high-accuracy point-of-care tests, have the potential to enable earlier detection of CD by facilitating screening and case-finding strategies at the primary care level,” Jan M. Heijdra Suasnabar, MSc, of the department of biomedical data science at Leiden University Medical Center, and colleagues wrote in Gastroenterology. “By identifying individuals with CD earlier, treatment can be initiated promptly, leading to improved health outcomes, reduced disease burden and potentially cost savings.”
Using a decision tree and Markov model, the researchers created a hypothetical cohort of children aged 3 years with celiac disease to estimate the long-term cost-effectiveness of point-of-care tests vs. the current practice of clinical detection, which involves no active efforts to identify at-risk children.
The point-of-care strategies evaluated were active case-finding, which was modeled after the country’s GLUTENSCREEN project of testing children with at least one celiac disease-related symptom during a routine visit at a youth health care center, and mass screening, which tests all children at a center regardless of symptomology.
The model parameters were informed by data collected during the GLUTENSCREEN project and from the Dutch Celiac Society and Dutch Pediatric Surveillance Unit, among other sources.
The researchers assessed each strategy’s effect on long-term costs, based on societal point of view, and quality-adjusted life years (QALYs), and reported incremental cost-effectiveness ratios (ICERs) between strategies.
According to study results, mass screening yielded 7.46 more QALYs and was 28,635 euro more costly compared with current care strategies (ICER = 3,841 euro/QALY). Similarly, active case-finding produced 4.33 more QALYs and was 15,885 euro more costly (ICER = 3,603 euro/QALY).
Despite being more costly, researchers reported both strategies were “highly cost-effective” at a willingness-to-pay threshold of 20,000 euro per QALY. However, when comparing all strategies at a willingness-to-pay threshold of 5,000 euro per QALY, mass screening was preferred.
Moreover, in a scenario analysis that assumed a modest benefit in identifying and treating asymptomatic cases, mass screening was again preferred.
“Secondary prevention by case-finding and mass screening for celiac disease in young children is cost-effective compared to the regular clinical standard of care,” Suasnabar and colleagues wrote. “These results contribute valuable insights about the economic benefits of celiac disease screening and case-finding strategies using a point-of-care test in the Netherlands.”
They continued: “The findings demonstrate how an earlier identification of celiac disease may lead to improved health outcomes, reduced disease burden and long-term savings in certain cost categories.”
Perspective
Back to Top
Deborah Goldman, MD
This study supports the concept of population screening or case findings in children with celiac disease in the Netherlands and that all children should be screened as part of routine pediatric care.
Interestingly, this concept of mass screening has been previously addressed, given the high prevalence of celiac disease worldwide. However, to date it has not been adopted as a universal part of pediatric care. A case-finding approach has been adopted with children who present with signs or symptoms compatible with celiac disease, or in populations with an increased risk, such as those with positive family history, trisomy 21, Turner syndrome or other autoimmune diseases.
Furthermore, celiac disease has myriad presentations, and the presence of symptoms is not predictive of disease; most screen-positive individuals have unrecognized symptoms. Clearly, the best way to improve diagnosis of children with unrecognized disease is using a mass-screening approach.
Future studies will need to address the feasibility of this approach and determine the best strategy, target population and frequency of screening. This study should be applauded, as mass screening has many benefits for patients and may also decrease economics of health care burden.
Collapse
Read more about
Click Here to Manage Email Alerts