Gastroenterology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Aliment Pharmacol Ther. 2010 Apr;31(8):901-10. doi: 10.1111/j.1365-2036.2010.04242.x. Epub 2010 Jan 19.
Coeliac disease is frequently diagnosed after a long delay resulting in increased morbidity and mortality.
To define the parameters which have the highest impact on the cost-effectiveness of mass screening for coeliac disease.
A Markov model examined a coeliac disease screening programme of the healthy young-adult general population compared with a no-screening strategy. The main outcome measures were quality adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER). Effects of variables were examined using sensitivity analyses.
The screening strategy resulted in a gain of 0.0027 QALYs. The ICER of screening vs. no-screening strategy was US$48,960/QALYs. The variables with the largest impact on cost effectiveness were: the time delay from symptom onset to diagnosis, the utility of adherence to a gluten-free diet (GFD) and the prevalence of coeliac disease. Screening would be cost-effective if the time delay to diagnosis is longer than 6 years and utility of GFD adherence is greater than 0.978.
Our model suggests that mass screening for coeliac disease of the young-adult general population is associated with improved QALYs and is a cost effectiveness strategy. Shortening of the time-delay to diagnosis by heightened awareness of health-care professionals may be a valid alternative to screening.
乳糜泻常常在很长的延迟后才被诊断出来，导致发病率和死亡率增加。
确定对乳糜泻大规模筛查的成本效益有最高影响的参数。
采用马尔可夫模型，对健康年轻成年人的乳糜泻筛查计划与不筛查策略进行了比较。主要的结果测量是质量调整生命年（QALYs）和增量成本效益比（ICER）。使用敏感性分析来检查变量的影响。
筛查策略导致 QALY 增加 0.0027。与不筛查策略相比，筛查的 ICER 为 48960 美元/QALY。对成本效益影响最大的变量是：从症状出现到诊断的时间延迟、对无麸质饮食（GFD）的依从性的效用以及乳糜泻的流行率。如果诊断的时间延迟超过 6 年，并且 GFD 依从性的效用大于 0.978，那么筛查将具有成本效益。
我们的模型表明，对年轻成年人的一般人群进行乳糜泻大规模筛查可提高 QALYs，是一种具有成本效益的策略。通过提高卫生保健专业人员的认识，缩短诊断的时间延迟可能是筛查的有效替代方法。
