BMC Gastroenterol. 2021 Apr 9;21(1):159. doi: 10.1186/s12876-021-01737-1.

Fredrik Norström ¹, Anna Myléus ², Katrina Nordyke ³, Annelie Carlsson ⁴, Lotta Högberg ⁵, Olof Sandström ^3 6, Lars Stenhammar ⁵, Anneli Ivarsson ³, Lars Lindholm ³

Author information

• ¹Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden. fredrik.norstrom@umu.se.
• ²Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
• ³Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
• ⁴Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.
• ⁵Department of Paediatrics, Norrköping Hospital, Linköping University, Norrköping, Sweden.
• ⁶Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.

Abstract

Background: Living with undiagnosed symptomatic coeliac disease is connected with deteriorated health, and persons with coeliac disease often wait a long time for their diagnosis. A mass screening would lower the delay, but its cost-effectiveness is still unclear. Our aim was to determine the cost-effectiveness of a coeliac disease mass screening at 12 years of age, taking a life course perspective on future benefits and drawbacks.

Methods: The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model. As a basis for our assumptions, we mainly used information from the Exploring the Iceberg of Celiacs in Sweden (ETICS) study, a school-based screening conducted in 2005/2006 and 2009/2010, where 13,279 12-year-old children participated and 240 were diagnosed with coeliac disease, and a study involving members of the Swedish Coeliac Association with 1031 adult participants.

Results: The cost for coeliac disease screening was 40,105 Euro per gained QALY. Sensitivity analyses support screening based on high compliance to a gluten-free diet, rapid progression from symptom-free coeliac disease to coeliac disease with symptoms, long delay from celiac disease with symptoms to diagnosis, and a low QALY score for undiagnosed coeliac disease cases.

Conclusions: A coeliac disease mass screening is cost-effective based on the commonly used threshold of 50,000 Euro per gained QALY. However, this is based on many assumptions, especially regarding the natural history of coeliac disease and the effects on long-term health for individuals with coeliac disease still eating gluten.