Digestive Diseases and Sciences

, Volume 53, Issue 3, pp 680–688 | Cite as

Cost-effectiveness Analysis of Strategies for Diagnosing Celiac Disease

  • Spencer D. DornEmail author
  • David B. Matchar
Original Paper


Objective To compare strategies for diagnosing celiac disease (CD). Methods A decision analytic model was used to compare five strategies on diagnostic performance and costs. Results First, tTG screening alone is the least costly strategy ($22/individual). While the NPV is high (99.8%), the PPV is low (63.4%). Second, if tTG-positive patients undergo esophagogastroduodenoscopy (EGD) to confirm CD, the PPV increases to 100% ($2,237/false-positive diagnosis avoided). Third, if EGDs are restricted to only those who are both tTG and HLA DQ2/8 positive, costs are slightly reduced ($59 vs. $63/individual), while PPV and NPV remain unchanged. Fourth, screening tTG-negative patients for IgA deficiency increases the NPV to 99.9% ($32,605/false-negative diagnosis avoided). Sensitivity analyses revealed that as the prevalence of CD increases, the cost of avoiding a false-positive diagnosis by adding EGD to the tTG alone strategy increases considerably. Conclusions When the pre-test probability of CD is low, patients with positive tTG serology should undergo EGD with biopsy—either directly or after positive screening for HLA DQ2/8—to confirm CD. As the pre-test probability of CD increases, the added cost of EGD should be weighed against the consequences of a false-positive diagnosis. Routinely screening for IgA deficiency in order to avoid a false-negative diagnosis is quite costly.


Cost effectiveness Celiac disease Diagnosis 



Grant support: supported by NIH grant T32DK7634


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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyUniversity of North CarolinaChapel HillUSA
  2. 2.Center for Clinical Health Policy ResearchDuke UniversityDurhamUSA
  3. 3.Department of MedicineDuke University Medical CenterDurhamUSA
  4. 4.Durham VA Medical CenterDurhamUSA

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