Skip to main content
SpringerLink
Log in

Direct Costs in Patients with Celiac Disease in the USA: A Retrospective Claims Analysis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Celiac disease (CeD) is an autoimmune disease triggered by gluten ingestion.

Aim

We assessed total direct costs burden associated with CeD in patients with CeD versus patients without CeD using administrative claims data.

Methods

Patients with CeD (cases) with ≥1 occurrences of CeD diagnosis were selected at a randomly chosen date (index date) from the OptumHealth Reporting and Insights database from 01/01/1998 through 03/31/2013. Cases were continuously enrolled throughout baseline (1 year before index date) and study (1 year after index date) periods. Cases were categorized as full remission and partial remission and matched 1:1 based on age, sex, region, index date, company, and employment status. Total all-cause and CeD-related costs were calculated.

Results

A total of 12,187 cases were matched with an equal number of controls. Mean total all-cause costs were $12,217 in cases versus $4935 in controls (P < 0.0001). In full remission (N = 10,181 [83.5 %]) and partial remission (N = 2006 [16.5 %]) cases, mean total all-cause direct costs (cases versus controls) were $11,038 versus $4962 and $18,206 versus $4796, respectively. All-cause medical costs ($9839 for all cases, $8723 for full remission cases, $15,499 for partial remission cases) accounted for the majority of all-cause total costs and included outpatient costs ($6675; $6456; and $7785, respectively) and hospitalizations ($2776; $1963; and $6906, respectively). CeD-related medical costs were 13 and 27 % of all-cause medical costs for all cases and partial remission cases, respectively.

Conclusions

Patients with CeD and partial remission of CeD incurred significantly higher (2.5 and 3.8 times) total all-cause costs compared with matched controls.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Lauret E, Rodrigo L. Celiac disease and autoimmune-associated conditions. Biomed Res Int. 2013;2013:127589.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fedorak RN, Switzer CM, Bridges RJ. Canadian Digestive Health Foundation Public Impact Series 4: celiac disease in Canada. Incidence, prevalence, and direct and indirect economic impact. Can J Gastroenterol. 2012;26:350–352.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Silvester JA, Rashid M. Long-term follow-up of individuals with celiac disease: an evaluation of current practice guidelines. Can J Gastroenterol. 2007;21:557–564.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Green PH. The many faces of celiac disease: clinical presentation of celiac disease in the adult population. Gastroenterology. 2005;128:S74–S78.

    Article  PubMed  Google Scholar 

  5. Rampertab SD, Pooran N, Brar P, Singh P, Green PH. Trends in the presentation of celiac disease. Am J Med. 2006;119:e9–e14.

    Article  Google Scholar 

  6. Pynnonen PA, Isometsa ET, Aronen ET, Verkasalo MA, Savilahti E, Aalberg VA. Mental disorders in adolescents with celiac disease. Psychosomatics. 2004;45:325–335.

    Article  PubMed  Google Scholar 

  7. Atteno M, Costa L, Tortora R, et al. The occurrence of lower limb enthesopathy in coeliac disease patients without clinical signs of articular involvement. Rheumatology (Oxford). 2013;52:893–897.

    Article  Google Scholar 

  8. Elli L, Bonura A, Garavaglia D, et al. Immunological comorbity in coeliac disease: associations, risk factors and clinical implications. J Clin Immunol. 2012;32:984–990.

    Article  CAS  PubMed  Google Scholar 

  9. Hizli S, Karabulut H, Ozdemir O, et al. Sensorineural hearing loss in pediatric celiac patients. Int J Pediatr Otorhinolaryngol. 2011;75:65–68.

    Article  PubMed  Google Scholar 

  10. Moccia M, Pellecchia MT, Erro R, et al. Restless legs syndrome is a common feature of adult celiac disease. Mov Disord. 2010;25:877–881.

    Article  PubMed  Google Scholar 

  11. Ansaldi N, Palmas T, Corrias A, et al. Autoimmune thyroid disease and celiac disease in children. J Pediatr Gastroenterol Nutr. 2003;37:63–66.

    Article  PubMed  Google Scholar 

  12. Martinelli D, Fortunato F, Tafuri S, Germinario CA, Prato R. Reproductive life disorders in Italian celiac women. A case-control study. BMC Gastroenterol. 2010;10:89.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Green PH, Fleischauer AT, Bhagat G, Goyal R, Jabri B, Neugut AI. Risk of malignancy in patients with celiac disease. Am J Med. 2003;115:191–195.

    Article  PubMed  Google Scholar 

  14. Ludvigsson JF, Inghammar M, Ekberg M, Egesten A. A nationwide cohort study of the risk of chronic obstructive pulmonary disease in coeliac disease. J Intern Med. 2012;271:481–489.

    Article  CAS  PubMed  Google Scholar 

  15. Ludvigsson JF, Rubio-Tapia A, Chowdhary V, Murray JA, Simard JF. Increased risk of systemic lupus erythematosus in 29,000 patients with biopsy-verified celiac disease. J Rheumatol. 2012;39:1964–1970.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Delco F, El-Serag HB, Sonnenberg A. Celiac sprue among US military veterans: associated disorders and clinical manifestations. Dig Dis Sci. 1999;44:966–972.

    Article  CAS  PubMed  Google Scholar 

  17. Ludvigsson JF, Zingone F, Tomson T, Ekbom A, Ciacci C. Increased risk of epilepsy in biopsy-verified celiac disease: a population-based cohort study. Neurology. 2012;78:1401–1407.

    Article  CAS  PubMed  Google Scholar 

  18. Welander A, Prutz KG, Fored M, Ludvigsson JF. Increased risk of end-stage renal disease in individuals with coeliac disease. Gut. 2012;61:64–68.

    Article  PubMed  Google Scholar 

  19. Ludvigsson JF, James S, Askling J, et al. Nationwide cohort study of risk of ischemic heart disease in patients with celiac disease. Circulation. 2011;123:483–490.

    Article  PubMed  Google Scholar 

  20. Lebwohl B, Granath F, Ekbom A, Stenestrand U, Ingelsson E. Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study. Ann Intern Med. 2013;159:169–175.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Zugna D, Richiardi L, Akre O, Stephansson O, Ludvigsson JF. A nationwide population-based study to determine whether coeliac disease is associated with infertility. Gut. 2010;59:1471–1475.

    Article  PubMed  Google Scholar 

  22. Ludvigsson JF, Montgomery SM, Ekbom A. Celiac disease and risk of adverse fetal outcome: a population-based cohort study. Gastroenterology. 2005;129:454–463.

    Article  PubMed  Google Scholar 

  23. Ludvigsson JF, West J, Card T, Appelros P. Risk of stroke in 28,000 patients with celiac disease: a nationwide cohort study in Sweden. J Stroke Cerebrovasc Dis. 2012;21:860–867.

    Article  PubMed  Google Scholar 

  24. Lee AR, Ng DL, Zivin J, Green PH. Economic burden of a gluten-free diet. J Hum Nutr Diet. 2007;20:423–430.

    Article  CAS  PubMed  Google Scholar 

  25. Zarkadas M, Cranney A, Case S, et al. The impact of a gluten-free diet on adults with coeliac disease: results of a national survey. J Hum Nutr Diet. 2006;19:41–49.

    Article  CAS  PubMed  Google Scholar 

  26. Dewar DH, Donnelly SC, McLaughlin SD, Johnson MW, Ellis HJ, Ciclitira PJ. Celiac disease: management of persistent symptoms in patients on a gluten-free diet. World J Gastroenterol. 2012;18:1348–1356.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Pulido O, Zarkadas M, Dubois S, et al. Clinical features and symptom recovery on a gluten-free diet in Canadian adults with celiac disease. Can J Gastroenterol. 2013;27:449–453.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Violato M, Gray A, Papanicolas I, Ouellet M. Resource use and costs associated with coeliac disease before and after diagnosis in 3,646 cases: results of a UK primary care database analysis. PLoS One. 2012;7:e41308.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Long KH, Rubio-Tapia A, Wagie AE, et al. The economics of coeliac disease: a population-based study. Aliment Pharmacol Ther. 2010;32:261–269.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Green PH, Neugut AI, Naiyer AJ, Edwards ZC, Gabinelle S, Chinburapa V. Economic benefits of increased diagnosis of celiac disease in a national managed care population in the United States. J Insur Med. 2008;40:218–228.

    PubMed  Google Scholar 

  31. Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA; American College of Gastroenterology. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol. 2013;108:656–76; quiz 677.

  32. Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol. 1993;46:1075–9; discussion 1081–1090.

  33. Cohen R, Skup M, Ozbay AB, et al. Direct and indirect healthcare resource utilization and costs associated with ulcerative colitis in a privately-insured employed population in the US. J Med Econ. 2015;18:447–456.

    Article  PubMed  Google Scholar 

  34. Thorne J, Tundia N, Skup M, et al. Direct and indirect resource use and costs associated with non-infectious non-anterior uveitis. 2014; 479: ARVO abstract 5320-C0138. http://www.arvo.org/webs/am2014/abstract/sessions/479.pdf. Accessed May 15, 2015.

Download references

Acknowledgments

The authors thank Joann Hettasch (Arbor Communications, Inc., Ann Arbor, MI) for medical writing support, which was funded by AbbVie, Inc., North Chicago, IL. Financial support for this study was provided entirely by AbbVie Inc. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The following authors are employed by the sponsor: Namita Tundia, Roopal Thakkar, and Mahesh Fuldeore.

Author information

Authors and Affiliations

  1. University of Chicago, 5721 S. Maryland Avenue, Chicago, IL, 60637, USA

    Stefano Guandalini

  2. AbbVie Inc., 1 N Waukegan Road, North Chicago, IL, 60064, USA

    Namita Tundia, Roopal Thakkar & Mahesh Fuldeore

  3. Analysis Group, 10 Rockefeller Plaza, 15th Floor, New York, NY, 10020, USA

    Dendy Macaulay

  4. Alvine Pharmaceuticals, 75 Shoreway Road, Suite B, San Carlos, CA, 94070, USA

    Kirk Essenmacher

Authors
  1. Stefano Guandalini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Namita Tundia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roopal Thakkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dendy Macaulay
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kirk Essenmacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mahesh Fuldeore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefano Guandalini.

Ethics declarations

Conflict of interest

S. Guandalini has worked as a Consultant for AbbVie Inc.; D. Macaulay is an employee of Analysis Group and under contract with AbbVie Inc.; K. Essenmacher is an employee and stockholder of Alvine Pharmaceuticals; and N. Tundia, R. Thakkar, and M. Fuldeore are employees and stockholders of AbbVie Inc.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 60 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guandalini, S., Tundia, N., Thakkar, R. et al. Direct Costs in Patients with Celiac Disease in the USA: A Retrospective Claims Analysis. Dig Dis Sci 61, 2823–2830 (2016). https://doi.org/10.1007/s10620-016-4219-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-016-4219-x

Keywords

Search

Navigation