The European Journal of Health Economics

, Volume 14, Issue 6, pp 947–957 | Cite as

Targeted screening for Coeliac Disease among irritable bowel syndrome patients: analysis of cost-effectiveness and value of information

  • Leyla Mohseninejad
  • Talitha Feenstra
  • Henriëtte E. van der Horst
  • Hèlen Woutersen-Koch
  • Erik Buskens
Original Paper

Abstract

Objectives

A high prevalence of Coeliac Disease (CD) is found among patients with a clinical diagnosis of irritable bowel syndrome (IBS) compared to the general population. Symptoms of CD are quite similar to IBS, but its treatment is different. The aim of this study was to evaluate the cost-effectiveness of screening for CD in patients with diarrhoea/mixed type IBS (IBS-D/mix) in terms of cost per quality adjusted life year (QALY) in the Netherlands.

Methods

A decision model was constructed to evaluate the costs and health benefits of serological testing followed by confirmatory endoscopy with biopsy. Probabilistic sensitivity analysis (PSA) was performed to examine the effect of parameter uncertainty. Finally, the budget impact of implementing the screening process was also computed for implementation over a 10-year time horizon.

Results

Screening resulted in an increase of about 0.07 quality life years (QALYs) per patient over a lifetime horizon. The incremental cost effectiveness ratio was about 6,200 €/QALY compared to no screening. The PSA showed that the uncertainty in cost effectiveness results is not considerable. The value of information analysis confirmed the robustness of the results. Screening all current patients with diarrhea/mixed type IBS would require a total budget of about 25 million Euros over a 10 year time period.

Conclusion

Screening patients with IBS-D or IBS-mix for CD is almost certainly cost-effective. The screening program would improve the quality of life of those patients with IBS symptoms who actually have CD at a relatively low cost.

Keywords

Irritable bowel syndrome Coeliac Disease Cost-effectiveness analysis Value of information analysis Screening 

JEL Classification

I18 

References

  1. 1.
    Inadomi, J.M., Fennerty, M.B., Bjorkman, D.: Systemic review: the economic impact of irritable bowel syndrome. Aliment. Pharmacol. Ther. 18, 671–682 (2003)PubMedCrossRefGoogle Scholar
  2. 2.
    Hungin, A.P.S., Whorwell, P.J., Tack, J., Mearin, F.: The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40 000 subjects. Aliment. Pharmacol. Ther. 17, 643–650 (2003)PubMedCrossRefGoogle Scholar
  3. 3.
    Akehurst, R.L., Brazier, J.E., Mathers, N., O’Keefe, C., Kaltenthaler, E., Morgan, A.: Health-related quality of life and cost impact of irritable bowel syndrome in a UK primary care setting. Pharmacoeconomics 20(7), 455–462 (2002)PubMedCrossRefGoogle Scholar
  4. 4.
    ten Berg, M.J., Goettsch, W.G., van den Boom, G., Smout, A.J., Herings, R.M.: Quality of life of patients with irritable bowel syndrome is low compared to others with chronic diseases. Eur. J. Gastroen. Hepat. 18(5), 475–481 (2006)Google Scholar
  5. 5.
    Bracco, A., Jonsson, B., Ricci, J.F., Drummond, M., Nyhlin, H.: Economic evaluation of tegaserod vs. placebo in the treatment of patients with irritable bowel syndrome: an analysis of the TENOR study. Value Health 10(4), 238–246 (2007)PubMedCrossRefGoogle Scholar
  6. 6.
    Brazier, J., Dolan, P., Karampela, K., Towers, I.: Does the whole equal the sum of the parts? Patient-assigned utility scores for IBS-related health states and profiles. Health Econ. 15(6), 543–551 (2006)PubMedCrossRefGoogle Scholar
  7. 7.
    Brazier, J., Roberts, J., Deverill, M.: The estimation of a preference-based measure of health from the SF-36. J. Health Econ. 21(2), 271–292 (2002)PubMedCrossRefGoogle Scholar
  8. 8.
    Brazier, J., Usherwood, T.: Deriving a preference based single utility index from the UK SF36 health survey. J. Clin. Epidemiol. 51(11), 1115–1128 (1998)PubMedCrossRefGoogle Scholar
  9. 9.
    Bushnell, D.M., Martin, M.L., Ricci, J.F., Bracco, A.: Performance of the EQ-5D in patients with irritable bowel syndrome. Value Health 9(2), 90–97 (2006)PubMedCrossRefGoogle Scholar
  10. 10.
    Spiegel, B., Harris, L., Lucak, S., Mayer, E., Naliboff, B., Bolus, R., Esrailian, E., Chey, W.D., Lembo, A., Karsan, H., Tillisch, K., Dulai, G., Talley, J., Chang, L.: Developing valid and reliable health utilities in irritable bowel syndrome: results from the IBS PROOF Cohort. Am. J. Gastroenterol. 104(8), 1984–1991 (2009)PubMedCrossRefGoogle Scholar
  11. 11.
    Gray, A.M., Papanicolas, I.N.: Impact of symptoms on quality of life before and after diagnosis of coeliac disease: results from a UK population survey. BMC Health Serv. Res. 10, 105 (2010)PubMedCrossRefGoogle Scholar
  12. 12.
    Sanders, D.S., Carter, J.C., Hurlstone, D.P., Pearce, A., Ward, A.M., McAlindon, M.E., Lobo, A.J.: Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care. Lancet 358, 1504–1508 (2001)PubMedCrossRefGoogle Scholar
  13. 13.
    Sanders, D.S., Patel, D., Stephenson, T.J., Ward, A.M., McCloskey, E.V., Hadjivassiliou, M., Lobo, A.J.: A primary care cross-sectional study of undiagnosed adult coeliac disease. Eur. J. Gastroen. Hepat. 15, 407–413 (2003)CrossRefGoogle Scholar
  14. 14.
    Shahbazkhani, B., Forootan, M., Merat, S., Akbari, M.R., Nasserimoghadam, S., Vahedi, H., Malekzadeh, R.: Coeliac disease presenting with symptoms of irritable bowel syndrome. Aliment. Pharmacol. Ther. 15, 231–235 (2003)CrossRefGoogle Scholar
  15. 15.
    Hershcovici, T., Leshno, M., Goldin, E., Shamir, R., Israeli, E.: Cost effectiveness of mass screening for coeliac disease is determined by time-delay to diagnosis and quality of life on a gluten-free diet. Aliment. Pharmacol. Ther. 31, 901–910 (2010)PubMedGoogle Scholar
  16. 16.
    Mein, S.M., Ladabaum, U.: Serological testing for coeliac disease in patients with symptoms of irritable bowel syndrome: a cost-effectiveness analysis. Aliment. Pharmacol. Ther. 19, 1199–1210 (2004)PubMedCrossRefGoogle Scholar
  17. 17.
    Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care (Clinical Practice Guideline). National Institute for Health and Clinical Excellence (2008)Google Scholar
  18. 18.
    Spiegel, B.M., DeRosa, V.P., Gralnek, I.M., Wang, V., Dulai, G.S.: Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis. Gastroenterology 126(7), 1721–1732 (2004)PubMedCrossRefGoogle Scholar
  19. 19.
    Shamir, R., Hernell, O., Leshno, M.: Cost-effectiveness analysis of screening for celiac disease in the adult population. Med. Decis. Making 26, 282–293 (2006)PubMedCrossRefGoogle Scholar
  20. 20.
    van der Veek, P.P.J., van Rood, Y.R., Masclee, A.A.M.: Clinical trial: short- and long-term benefit of relaxation training for irritable bowel syndrome. Aliment. Pharmacol. Ther. 26, 943–952 (2007)PubMedCrossRefGoogle Scholar
  21. 21.
    WGO-OMGE Practice Guideline: Celiac Disease. World Gastroenterology Organisation (WGO-OMGE), Paris (2007)Google Scholar
  22. 22.
    Richtlijnen voor farmaco-economisch onderzoek, geactualiseerde versie (Guidelines for pharmacoeconomic research, updated version). College voor zorgverzekeringen (College of Health Insurances, CVZ) (2006)Google Scholar
  23. 23.
    Richtlijn Coeliakie en Dermatitis Herpetiformis (Coeliac Disease and Dermatitis Herpetiformis Guideline). Nederlandse Vereniging van Maag-Darm-Leverartsen (Dutch Association of Gastroenterologists and Hepatologists) (2008)Google Scholar
  24. 24.
    van der Linden, M., Westert, G. P., De Bakker, D. H., Schellevis, F. G.: Tweede Nationale studie naar ziekten en verrichtingen in de huisartspraktijk. Klachten en aandoeningen in de bevolking en in de huisartspraktijk (The second Dutch national survey of general practice. Complaints and disorders in the population and in general practice). NIVEL, Utrecht (2004)Google Scholar
  25. 25.
    Damoiseaux, J. G. M. C., Damoiseaux, R. A. M. J.: Coeliakiediagnostiek bij de huisarts (Celiac disease diagnosis in the General practice). Huisarts Wet (General Practitioners & Science) 48(1):24–27 (2005)Google Scholar
  26. 26.
    Sanquin Blood Supply Foundation. http://www.sanquin.nl (1998). Accessed 6 Apr 2010
  27. 27.
    Nederlandse Zorgautoriteit (Dutch Healthcare Authority). http://dbc-tarieven.nza.nl/Nzatarieven/top.do. Accessed 2 Aug 2010
  28. 28.
    Goettsch, W.G., van den Boom, G., Breekveldt-Postma, N.S., Smout, A.J.P.M., Herings, R.M.C.: Treatment patterns and health care costs of mebeverine-treated IBS patients: a case-control study. Pharmacol. Drug Saf. 13, 803–810 (2004)CrossRefGoogle Scholar
  29. 29.
    Dutch Coeliac Disease organization. http://www.glutenvrij.nl (2010). Accessed 2 Aug 2010
  30. 30.
    Statistics Netherlands. www.cbs.nl (2003). Accessed 14 June 2010
  31. 31.
    Riteco, J. A., de Heij, L., Luijn, J. C. F., Wolff, I. R.: Richtlijnen voor farmaco-economisch onderzoek, geactualiseerde versie (Guidelines for pharmacoeconomic research, updated version). College voor zorgverzekeringen (College of Health Insurances, CVZ) (1999)Google Scholar
  32. 32.
    Rostami, K., Mulder, C.J., Werre, J.M., van Beukelen, F.R., Kerckhaert, J., Crusius, J.B., Peña, A.S., Willekens, F.L., Meijer, J.W.: High prevalence of celiac disease in apparently healthy blood donors suggests a high prevalence of undiagnosed celiac disease in the Dutch population. Scand. J. Gastroenterol. 34(3):276–279 (1999)Google Scholar
  33. 33.
    Briggs, A., Sculpher, M., Claxton, K.: Decision Modelling for Health Economic Evaluation, 1st edn. Oxford University Press, Oxford (2006)Google Scholar
  34. 34.
    Claxton, K., Neumann, P.J., Araki, S., Weinstein, M.C.: Bayesian value of information analysis: an application to a policy model of Alzheimer’s disease. Int. J. Technol. Assess. Health Care 17(1), 38–55 (2001)PubMedCrossRefGoogle Scholar
  35. 35.
    Fasano, A., Berti, I., Gerarduzzi, T., Not, T., Colletti, R.B., Drago, S., Elitsur, Y., Green, P.H., Guandalini, S., Hill, I.D., Pietzak, M., Ventura, A., Thorpe, M., Kryszak, D., Fornaroli, F., Wasserman, S.S., Murray, J.A., Horvath, K.: Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch. Intern. Med. 163(3), 286–292 (2003)PubMedCrossRefGoogle Scholar
  36. 36.
    Woutersen-Koch, H., Smout, A.J.P.M., Flik, C.E., Hulshof, C.T.J., de Wit, N.J., van der Horst, H.E.: Multidisciplinaire richtlijn prikkelbaredarmsyndroom (Multidisciplinary guideline for irritable bowel syndrome). Nederlands Tijdschrift voor Geneeskunde (Neth. J. Med.) 156, A4584 (2012)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Leyla Mohseninejad
    • 1
  • Talitha Feenstra
    • 1
  • Henriëtte E. van der Horst
    • 2
  • Hèlen Woutersen-Koch
    • 3
  • Erik Buskens
    • 1
  1. 1.Department of Epidemiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  2. 2.Department of General Practice, EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
  3. 3.Dutch College of General PractitionersUtrechtThe Netherlands

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