title: Clinical relevance and cost-effectiveness of HLA genotyping in children with Type 1 diabetes mellitus in screening for coeliac disease in the Netherlands.
abstract: OBJECTIVE
  To investigate the clinical relevance and cost-effectiveness of human leukocyte antigen (HLA)-genotyping in the Netherlands as a screening tool for the development of coeliac disease in children with Type 1 diabetes mellitus.
  
  
  METHODS
  A retrospective analysis was performed in 110 children with Type 1 diabetes mellitus diagnosed between January 1996 and January 2013. All children were screened for coeliac disease using coeliac disease-specific antibodies and HLA genotyping was performed in all children.
  
  
  RESULTS
  One hundred and ten children were screened for coeliac disease, and coeliac disease could be confirmed in seven. Eighty-six per cent of the children with Type 1 diabetes mellitus had one of the variants of HLA-DQ2.5 and DQ8. HLA genotypes observed in children with Type 1 diabetes mellitus children and coeliac disease were heterozygote DQ2.5, homozygote DQ2.5 and heterozygote DQ2.5/DQ8. HLA genotyping in coeliac disease screening in children with Type 1 diabetes mellitus is more expensive than screening for coeliac disease with antibodies alone (€326 vs. €182 per child).
  
  
  CONCLUSIONS
  The risk of coeliac disease development in children with Type 1 diabetes mellitus is increased when they are heterozygote DQ2.5/DQ8, homozygote or heterozygote DQ2.5. The implementation of HLA genotyping as a first-line screening tool has to be reconsidered because it is not distinctive or cost-effective.
authors.affiliation: Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands.|Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Elias
authors.affiliation: Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: J J G
authors.initials: JJ
authors.lastname: Hoorweg-Nijman
authors.affiliation: Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Balemans
mesh_terms: D002446:Celiac Disease / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000191:economics / Q000453:epidemiology / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000191:economics / Q000379:methods; D060005:Genotyping Techniques / Q000191:economics* / Q000379:methods; D006680:HLA Antigens / Q000235:genetics*; D006683:HLA-DQ Antigens / Q000235:genetics; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D009426:Netherlands / Q000453:epidemiology
chemical_list: D006680:HLA Antigens; D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; C109756:HLA-DQ8 antigen