Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

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.

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

Similar content being viewed by others

References

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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. 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)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

    Article  CAS  Google Scholar 

  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)

    Article  Google Scholar 

  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)

    PubMed  CAS  Google Scholar 

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

  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)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  21. WGO-OMGE Practice Guideline: Celiac Disease. World Gastroenterology Organisation (WGO-OMGE), Paris (2007)

  22. Richtlijnen voor farmaco-economisch onderzoek, geactualiseerde versie (Guidelines for pharmacoeconomic research, updated version). College voor zorgverzekeringen (College of Health Insurances, CVZ) (2006)

  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)

  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)

  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. Sanquin Blood Supply Foundation. http://www.sanquin.nl (1998). Accessed 6 Apr 2010

  27. Nederlandse Zorgautoriteit (Dutch Healthcare Authority). http://dbc-tarieven.nza.nl/Nzatarieven/top.do. Accessed 2 Aug 2010

  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)

    Article  Google Scholar 

  29. Dutch Coeliac Disease organization. http://www.glutenvrij.nl (2010). Accessed 2 Aug 2010

  30. Statistics Netherlands. www.cbs.nl (2003). Accessed 14 June 2010

  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)

  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. Briggs, A., Sculpher, M., Claxton, K.: Decision Modelling for Health Economic Evaluation, 1st edn. Oxford University Press, Oxford (2006)

    Google Scholar 

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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 

Download references

Author information

Authors and Affiliations

  1. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands

    Leyla Mohseninejad, Talitha Feenstra & Erik Buskens

  2. Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands

    Henriëtte E. van der Horst

  3. Dutch College of General Practitioners, Postbus 3231, 3502 GE, Utrecht, The Netherlands

    Hèlen Woutersen-Koch

Authors
  1. Leyla Mohseninejad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Talitha Feenstra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henriëtte E. van der Horst
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hèlen Woutersen-Koch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erik Buskens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leyla Mohseninejad.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mohseninejad, L., Feenstra, T., van der Horst, H.E. et al. Targeted screening for Coeliac Disease among irritable bowel syndrome patients: analysis of cost-effectiveness and value of information. Eur J Health Econ 14, 947–957 (2013). https://doi.org/10.1007/s10198-012-0441-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-012-0441-4

Keywords

JEL Classification

Search

Navigation