Some patients with diarrhea-predominant irritable bowel syndrome may have undiagnosed celiac sprue.
Testing for celiac sprue in patients with irritable bowel syndrome may prevent years of morbidity and associated expense.
|Testing is the dominant strategy when prevalence is 8%.|
In this study, researchers from the United States determined whether testing for celiac sprue was a cost-effective diagnostic strategy in patients with diarrhea-predominate irritable bowel syndrome.
The team used decision analysis to calculate the cost-effectiveness of 2 competing strategies:
- Empirical irritable bowel syndrome treatment.
- Serologic testing for celiac sprue, followed by endoscopic biopsy for positive tests.
The researchers found that the base-case cohort had a celiac sprue prevalence of 3.4%.
They found that testing for celiac sprue instead of starting irritable bowel syndrome therapy cost an incremental $11,000 to achieve 1 additional symptomatic improvement.
However, they determined that testing for celiac sprue became the dominant strategy when the prevalence of celiac disease in the population exceeded 8%.
When the prevalence dropped to below 1%, the incremental cost-effectiveness of testing for celiac sprue exceeded $50,000.
Dr Brennan Spiegel and colleagues concluded, “Testing for celiac sprue in patients with diarrhea-predominant irritable bowel syndrome has an acceptable cost when the prevalence…is above 1% and is the dominant strategy when the prevalence exceeds 8%”.
“The decision to test should be based on a consideration of the population prevalence of underlying celiac sprue, the operating characteristics of the screening test employed, and the cost of proposed therapy for irritable bowel syndrome”.