Epidemiology and Economic Impact of Celiac Disease in the South Vesuvian Area of Naples: A Survey

Abstract

Celiac disease is a chronic digestive disorder of genetic origin in which damage to the lining of the small intestine, caused by an immunological reaction to gluten, leads to the malabsorption of minerals and nutrients (1). Signs and symptoms of celiac disease may vary among individuals depending on the degree of malabsorption: they range from absent, few or mild, to many or severe. There is no specific cure for celiac disease; the main treatment is a gluten-free diet (2). The social impact of celiac disease is very high and its estimated prevalence in Italy is about 1.5%. The Italian law no.123 (July 4, 2005) recognizes the celiac disease as “social disease” and ensures the free distribution of gluten-free aliments. However, there is no national legislation regulating the delivery modalities of gluten-free foods for patients with celiac disease; there are only some regional laws or even internal corporate regulations that establish the paths of delivery of gluten-free foods. In the Local Sanitary Agency (LSA) Naples 3 South Italy (i.e., LSA, NA 3 South), patients with celiac disease are taken into care by the Units of Basic Medicine of their Health District (a subunit of the LSA); subsequently, the pharmaceutical service emits a booklet composed of 12 coupons corresponding to the 12 months of the year. The value in euro of each coupon varies according to age and gender of the patient as reported in a table of a specific Ministerial Decree (May 4, 2006); it determines exactly the expenditure cut-off for the delivery of gluten-free products. Patients can buy gluten-free foods using these coupons in any territorial pharmacy. Given the significant social impact of celiac disease and the increasing number of cases, we conducted a survey with the aim (i) to show the updated prevalence of the disease in a defined population and (ii) to evaluate the economic impact.