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Universal screening prevents hip and vertebral fractures in celiac disease

This month's issue of Clinical Gastroenterology & Hepatology investigates cost-effectiveness of universal serologic screening to prevent nontraumatic hip and vertebral fractures in patients with celiac disease.

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Patients with asymptomatic or poorly managed celiac disease can experience bone loss, placing them at risk for hip and vertebral fractures.

Dr Park and colleagues from California, USA analyzed the cost-effectiveness of universal serologic screening (USS) vs symptomatic at-risk screening strategies for celiac disease because of the risk of nontraumatic hip and vertebral fractures if untreated or undiagnosed.

The research team developed a lifetime Markov model of the screening strategies, each with male or female cohorts of 1000 patients who were 12 years old when screening began.

The team screened serum samples for levels of immunoglobulin A, compared with tissue transglutaminase and total immunoglobulin A, and findings were confirmed by mucosal biopsy.

Transition probabilities and quality of life estimates were obtained from the literature.

The average lifetime cost was $8532 for USS
Clinical Gastroenteorlogy & Hepatology

The researchers used generalizable cost estimates and Medicare reimbursement rates, and ran deterministic and probabilistic sensitivity analyses.

For men, the average lifetime costs were $8532 and $8472 for USS and symptomatic at-risk screening strategies, respectively, corresponding to average quality-adjusted life year gains of 25.511 and 25.515.

Similarly for women, costs were $11,383 and $11,328 for USS and symptomatic at-risk screening strategies, respectively, corresponding to quality-adjusted life year gains of 25.74 and 25.75.

The team noted that compared with the current standard of care, USS produced higher average lifetime costs and lower quality of life for each sex.

Deterministic and probabilistic sensitivity analyses showed that the model was robust to realistic changes in all the variables, making USS cost-ineffective on the basis of these outcomes.

Dr Park's team concludes, "USS and symptomatic at-risk screening are similar in lifetime costs and quality of life."

"The current symptomatic at-risk screening strategy was overall more cost-effective in preventing bone loss and fractures among patients with undiagnosed or subclinical disease."

"On the basis of best available supportive evidence, it is more cost-effective to maintain the standard celiac screening practices, although future robust population-based evidence in other health outcomes could be leveraged to reevaluate current screening guidelines."

Clin Gastroenterol Hepatol 2013: 11(6): 645-653
24 May 2013

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