title: Economic benefits of increased diagnosis of celiac disease in a national managed care population in the United States.
abstract: OBJECTIVE
  To estimate the rate of celiac disease diagnosis and evaluate the economic benefits of diagnosis by analyzing retrospective cohorts from a national managed-care-population database.
  
  
  METHODS
  We identified patients who received a new diagnosis of celiac disease. We also identified 3 control groups, persons without a diagnosis of celiac disease but who exhibited 1, 2, or 3 or more symptoms associated with the disease. Using claims, encounter, and eligibility data of approximately 10.2 million managed care members across the United States between January 1999 and December 2003, we measured and compared direct standardized relative value based (RVU) medical costs and utilization of selected health care services among the 4 study cohorts.
  
  
  RESULTS
  The rate of new diagnosis for celiac disease more than doubled over the 4-year period. The celiac disease cohort had a significant trend reduction in direct standardized medical costs relative to the three control groups. RVU-based medical costs in the celiac cohort were 24%, 33%, and 27% lower than cohort 1 (p<0.05), 29.0%, 38%, and 24% lower than cohort 2 (p<0.05), and 38%, 33%, and 31% lower than cohort 3 (p<0.01) for the 12-month, 24-month and 36-month post-diagnosis periods, respectively. The reductions in costs were attributable to decreasing trends in utilization of office visits, lab, diagnostic, imaging, and endoscopy procedures relative to the 3 comparative cohorts over the 3-year follow-up period.
  
  
  CONCLUSIONS
  There was an increase in the rate of celiac disease diagnosis, which was associated with significant reduction in direct standardized RVU-based medical costs and utilization of selected health care services over time.
authors.affiliation: Celiac Disease Center, Columbia University College of Physicians and Surgeons, Harkness Pavilion, 180 Fort Washington, Suite 956, New York, NY 10032, USA. pg11@columbia.edu
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Afzal J
authors.initials: AJ
authors.lastname: Naiyer
authors.forename: Z Collette
authors.initials: ZC
authors.lastname: Edwards
authors.forename: Susan
authors.initials: S
authors.lastname: Gabinelle
authors.forename: Vijit
authors.initials: V
authors.lastname: Chinburapa