Screening for Celiac Disease in Childhood: Cost-Effectiveness of Multiple Genetic and Serological Testing Approaches
Year: 2025
Type: article
Abstract: BACKGROUND & AIMS: Celiac disease is severely underdiagnosed, and many identified patients suffer from a long diagnostic delay. Population-based screening could improve this under-recognition, but its practical implementation remains unclear. We studied the most cost-effective screening strategy for celiac disease in childhood. METHODS: A Markov model using primarily Swedish data was developed for comparing the cost-effectiveness of various scenarios. Key considerations included serological testing across ages 3 to 18 years, single-time vs repeated screening, and preliminary genetic testing to identify the at-risk population. Outcomes of the resulting 272 strategies were compared against a no-screening alternative using the incremental cost-effectiveness ratio. Sensitivity analysis was conducted at a €20,000 willingness to pay threshold to determine key factors influencing the optimal screening age(s) and conditions where repeated screening would be preferred. RESULTS: Untargeted single-time screening was more cost-effective than repeated screening or the combined use of genetic testing in the default scenario. Single-time screening was most cost-effective at age 11 (95% confidence interval, 10-14 years), and repeated screening at ages 4 and 11. Repeated screening was preferred if prevalence of celiac disease at age 12 was ≥5%, diagnosis improved quality of life for asymptomatic patients, screening costs were halved, or a willingness to pay of €50,000 per quality-adjusted life year was adopted. Diagnostic delay was the key factor influencing the optimal screening age(s). CONCLUSIONS: The most cost-effective screening strategy for celiac disease was single-time untargeted serological testing at age 11. The optimal approach is affected by regional factors and may evolve with new evidence. Repeated screening may be preferable for high-risk groups and with high willingness to pay.
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,470
Funders: Univerzita Karlova v Praze, Helsingin Yliopisto, TU Graz, Internationale Beziehungen und Mobilitätsprogramme, Suomen Lääketieteen Säätiö, Università degli Studi di Siena, European Commission, Academy of Finland, Lunds Universitet, Emil Aaltosen Säätiö, Turun Yliopisto, Lastentautien Tutkimussäätiö, Oulun Yliopisto, Sigrid Juséliuksen Säätiö, Teknologian Tutkimuskeskus VTT, Paulon Säätiö, Tartu Ülikool, Åbo Akademi, Tays, Horizon 2020 Framework Programme, Faculty of Medicine and Health, University of Sydney, Norwegian Institute of Public Health
OpenAlex ID: W4417333284