title: Cost effectiveness of mass screening for coeliac disease is determined by time-delay to diagnosis and quality of life on a gluten-free diet.
abstract: BACKGROUND
  Coeliac disease is frequently diagnosed after a long delay resulting in increased morbidity and mortality.
  
  
  OBJECTIVE
  To define the parameters which have the highest impact on the cost-effectiveness of mass screening for coeliac disease.
  
  
  METHODS
  A Markov model examined a coeliac disease screening programme of the healthy young-adult general population compared with a no-screening strategy. The main outcome measures were quality adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER). Effects of variables were examined using sensitivity analyses.
  
  
  RESULTS
  The screening strategy resulted in a gain of 0.0027 QALYs. The ICER of screening vs. no-screening strategy was US$48,960/QALYs. The variables with the largest impact on cost effectiveness were: the time delay from symptom onset to diagnosis, the utility of adherence to a gluten-free diet (GFD) and the prevalence of coeliac disease. Screening would be cost-effective if the time delay to diagnosis is longer than 6 years and utility of GFD adherence is greater than 0.978.
  
  
  CONCLUSIONS
  Our model suggests that mass screening for coeliac disease of the young-adult general population is associated with improved QALYs and is a cost effectiveness strategy. Shortening of the time-delay to diagnosis by heightened awareness of health-care professionals may be a valid alternative to screening.
authors.affiliation: Gastroenterology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Hershcovici
authors.forename: M
authors.initials: M
authors.lastname: Leshno
authors.forename: E
authors.initials: E
authors.lastname: Goldin
authors.forename: R
authors.initials: R
authors.lastname: Shamir
authors.forename: E
authors.initials: E
authors.lastname: Israeli
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D057210:Delayed Diagnosis; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome