Gastroenterology. 2024 Nov;167(6):1129-1140.doi: 10.1053/j.gastro.2024.07.024. Epub 2024 Jul 29.

Jan Heijdra Suasnabar ¹, Caroline R Meijer ², Lucy Smit ³, Floris van Overveld ⁴, Howard Thom ⁵, Edna Keeney ⁵, M Luisa Mearin ², M Elske van den Akker-van Marle ⁶

Author information

¹Department of Biomedical Data Science, Leiden University Medical Centre, Leiden, the Netherlands. Electronic address: j.m.heijdra_suasnabar@lumc.nl.

²Department of Pediatric Gastroenterology, Willem-Alexander Children's Hospital, Leiden University Medical Center, the Netherlands.

³Youth Health Care Centre, Kennemerland, the Netherlands.

⁴Dutch Celiac Patients Society, Naarden, the Netherlands.

⁵Department of Population Health Sciences, Bristol Medical School, Bristol, United Kingdom.

⁶Department of Biomedical Data Science, Leiden University Medical Centre, Leiden, the Netherlands.

Abstract

Background & aims: Celiac disease (CD) is a common yet underdiagnosed autoimmune disease with substantial long-term consequences. High-accuracy point-of-care tests for CD antibodies conducted at youth primary health care centers may enable earlier identification of CD, but evidence about the cost-effectiveness of such strategies is lacking. We estimated the long-term cost-effectiveness of active case finding and mass screening compared with clinical detection in the Netherlands.

Methods: A decision tree and Markov model were used to simulate a cohort of 3-year-old children with CD according to each strategy, taking into account their impact on long-term costs (from a societal perspective) and quality-adjusted life-years (QALYs). Model parameters incorporated data from the GLUTENSCREEN project, the Dutch Celiac Society, the Dutch Pediatric Surveillance Unit, and published sources. The primary outcome was the incremental cost-effectiveness ratio (ICER) between strategies.

Results: Mass screening produced 7.46 more QALYs and was €28,635 more costly compared with current care (ICER: €3841 per QALY), and case finding produced 4.33 more QALYs and was €15,585 more costly compared with current care (ICER: €3603 per QALY). At a willingness to pay of €20,000 per QALY, both strategies were highly cost-effective compared with current care. Scenario analyses indicated that mass screening is likely the optimal strategy, unless no benefit in detecting asymptomatic cases is assumed.

Conclusions: An earlier identification of CD through screening or case finding in children using a point-of-care tests leads to improved health outcomes and is cost-effective in the long-term compared with current care. If the feasibility and acceptability of the proposed strategies are successful, implementation in Dutch regular care is needed.