Not only does celiac disease cause abdominal pain, diarrhea, and bloating—untreated disease leads to progressive bone loss and derangements, increasing the risk for early osteoporosis and fractures of the hip and vertebrae. The June issue of Clinical Gastroenterology and Hepatology reports that current screening strategies to identify people with celiac disease are cost effective, in that they prevent these bone defects, but that universal screening of all adolescents would not be cost effective.
Celiac disease is caused by an immune response to ingested gluten—a protein found in wheat, barley, rye, and possibly oats.
Over time, this reaction produces inflammation that damages the lining of the small intestine and prevents absorption of some nutrients. As many as 70% of untreated patients with celiac disease have reduced bone mineral density, which increases risk for osteoporosis and overall fractures by 30%.
Symptomatic individuals and those in high risk groups (who have family members with the disease) are typically screened for celiac disease by serologic tests, followed by endoscopy. Although these tests are relatively inexpensive and detect celiac disease with high levels of sensitivity and specificity, it is not clear if all people should be screened (i.e., universal screening), partially because of unclear long-term benefits to patients—especially if they are asymptomatic.
K.T. Park et al. constructed a decision analytic Markov model to compare the predicted cost-effectiveness of universal serologic screening of adolescents (12 years old) with that of standard screening (of only symptomatic adolecents or those with genetic risk factors for celiac disease), based on their ability to prevent hip and vertebral fractures.
They found that compared with the standard screening strategy, universal screening was not only more costly, but had a lower effect on quality of life for each sex, based on its ability to prevent bone loss and fractures among patients with undiagnosed or subclinical disease.
Park et al. conclude that adopting the universal screening strategy, in which virtually every preadolescent child would be routine screened for CD in the primary care setting, would be more expensive and fail to increase the long-term quality of life for entire population. They add that it could result in unnecessary endoscopic evaluations of healthy individuals when serologic tests produce false-positive results.
The authors recognized the concern that standard practice of screening for celiac disease misses a considerable proportion of asymptomatic CD patients. However, they say that there is no formal consensus on the precise long-term health benefits, if expanded screening effectively decreases the proportion of undiagnosed or untreated CD patients.
More Information on Celiac Disease:
Read the article online.
Park KT, Tsai R, Wang L, et al. Cost-effectiveness of universal serologic screening to prevent nontraumatic hip and vertebral fractures in patients with celiac disease. Clin Gastroenterol Hepatol 2013;11:645–653.