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  4. Resource use and costs associated with coeliac disease before and after diagnosis: a case control study

Resource use and costs associated with coeliac disease before and after diagnosis: a case control study

Principal investigator: Alastair Gray, Professor of Health Economics, Department of Public Health and Primary Care

Institution: University of Oxford

Research classifcation: Management of coeliac disease and dermatitis herpetiformis

Project completion: 2006 (publications 2010 and 2012)

Grant awarded: £25K

Despite the rising number of people diagnosed with coeliac disease, not much was known about the costs to the health service before and after diagnosis. This study provided new and original evidence on the economic impact of the disease in a UK primary care context.

Data from the UK General Practice Research Database (GPRD) were used to conduct the study. GPRD is one of the largest computerised databases of anonymised medical records from primary care in the UK and it includes medical diagnostic codes for consultations, tests, referrals and details of prescriptions issued. Patients can be tracked over many years, and data are routinely subject to quality checks in order to guarantee they are ‘up to standard’.

A cohort of 3,646 cases (people diagnosed with coeliac disease) and a cohort of 32,973 controls (people without coeliac disease, matched for age) were extracted from the GPRD.

The researchers looked at all consultations, tests, referrals and prescriptions amongst the cases over a period up to 10 years before and after diagnosis, converted this into an annual cost, and compared it with the costs amongst the control group.

Even 10 years prior to diagnosis with coeliac disease, the cases were incurring slightly higher costs each year compared to the controls. This reflects additional consultations, tests and referrals resulting from the symptoms of undiagnosed coeliac disease. After diagnosis, the annual costs of the coeliac cases increased, mainly as a result of increased prescription costs. On average, the difference in health service costs of the coeliac cases compared with the control group were approximately £91 each year pre-diagnosis and £354 post diagnosis.

This study shows significant additional primary care costs associated with coeliac disease. In particular, it shows that many patients are consulting their GPs and being referred for tests over a long period of time before coeliac disease is diagnosed, presumably as a result of coeliac-related symptoms. After diagnosis, there is much less evidence of additional diagnoses and tests, but prescribing increases substantially- increases in healthcare costs might be expected following diagnosis of many other conditions and diseases, for example to treat hypertension or diabetes.

Previous research has shown that patient quality of life improves enormously after their coeliac disease has been diagnosed (Gray AM and Papanicolas IN, 2010). So the evidence described here should help to inform debate about the possible benefits of screening for coeliac disease, and the cost-effectiveness of ensuring that gluten-free diets are maintained after diagnosis.

Associated publications:

Violato M, Gray A, Papanicolas I, et al. (2012) Resource use and costs associated with coeliac disease before and after diagnosis in 3,646 Cases: results of a UK primary care database analysis. PLoS ONE 7(7): e41308.

Gray AM, Papanicolas IN. (2010) Impact of symptoms on quality of life before and after diagnosis of coeliac disease: results from a UK population survey. BMC Health Services Research 10:105.

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