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Health Care Costs in Patients According to Work Ability at Celiac Disease Diagnosis: A Nationwide Cost-of-Illness Study

Year: 2025

Type: article

Abstract: BACKGROUND & AIMS: Evidence suggests that a minority of patients with celiac disease (CeD) experience impaired work ability, among whom greater health care needs could arise. However, their economic burden remains understudied. We assessed health care utilization and costs in CeD by work ability at diagnosis. METHODS: Through biopsy reports from all pathology departments in Sweden, we identified working-age individuals diagnosed with CeD during 2007 to 2017. Patients were categorized as having impaired (n = 2107) or sustained (n = 5833) work ability during the diagnosis year using nationwide social insurance register data. Absenteeism ≤14 days and presenteeism were not captured. Each patient was matched with ≤5 general population reference individuals. Health care costs were calculated using nationwide health registers, with excess costs adjusted by 2-part models combining logistic and generalized linear regressions. RESULTS: During the 3-year period around CeD diagnosis, mean cumulative health care cost in patients with impaired work ability was 3.71 times that of reference individuals (adjusted excess costs, $10,049 [2023 United States dollars]). Patients with sustained work ability had lower costs than those with impaired work ability but were still above the reference level (cost ratio, 1.39; adjusted excess costs, $1637). Higher excess costs in patients with impaired work ability were mainly non-CeD-related. Health care costs in this group remained elevated 3-fold even 5 years after diagnosis, whereas costs in patients with sustained work ability gradually returned to the reference level. CONCLUSIONS: Patients with impaired work ability at CeD diagnosis face a greater and more persistent economic burden than those with sustained work ability. The over-representation of non-CeD-related health care costs among them warrants personalized, multidisciplinary care to mitigate their multifactorial burdens.

Source: Clinical Gastroenterology and Hepatology

DOI: 10.1016/j.cgh.2025.12.003