Long-term cost-effectiveness of case-finding and mass-screening for coeliac disease in children

Abstract

Background and aimsCeliac disease (CD) is a common yet underdiagnosed autoimmune disease with substantial long-term consequences. High-accuracy point-of-care tests (POCTs) for CD antibodies conducted at youth primary healthcare centers (YHCCs) 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 to clinical detection in the Netherlands. MethodsA decision tree and Markov model were used to simulate a cohort of three-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. ResultsMass-screening produced 7.46 more QALYs and was € 28,635 more costly compared to current care (ICER: € 3841/QALY), and case-finding produced 4.33 more QALYs and was € 15,585 more costly compared to current care (ICER: € 3603/QALY). At a willingness to pay of € 20,000 per QALY, both strategies were highly cost-effective compared to current care. Scenario analyses indicated that mass-screening is likely the optimal strategy, unless no benefit in detecting asymptomatic cases is assumed. ConclusionAn earlier identification of CD through screening or case-finding in children using a POCT leads to improved health outcomes and is cost-effective in the long-term compared to current care. If the feasibility and acceptability of the proposed strategies are successful, implementation in Dutch regular care is needed.