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Universal serologic screening prevents nontraumatic fractures in celiac disease

This month's Clinical Gastroenterology & Hepatology investigates the 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 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.

The research team noted that transition probabilities and quality of life estimates were obtained from the literature.

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 universal serologic screening and symptomatic at-risk screening strategies, respectively, corresponding to average quality-adjusted life year gains of 25.511 and 25.515.

For men, the average lifetime costs were $8532 for universal serologic screening
Clinical Gastroenterology and Hepatology

The doctors found that similarly for women, costs were $11,383 and $11,328 for universal serologic screening and symptomatic at-risk screening strategies, respectively, corresponding to quality-adjusted life year gains of 25.74 and 25.75.

Compared with the current standard of care, universal serologic screening 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 universal serologic screening cost-ineffective on the basis of these outcomes.

Dr Park's team commented, "universal serologic screening and symptomatic at-risk screening are similar in lifetime costs and quality of life, although 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 and Hepatol 2013: 11(6) :645-653
26 June 2013

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