Coeliac disease: resource use and costs
Resource use and costs associated with coeliac disease before and after diagnosis: a case control study
|Information:||Mara Violato, Alastair Gray|
Coeliac disease (CD) is increasingly recognised as a common health problem, with an estimated prevalence (diagnosed and undiagnosed) of approximately 1% in Europe. Numbers diagnosed have risen sharply since the introduction of a simple blood test in the 1990s. At present very little is known about economic aspects of coeliac disease. The economic impact on patients, the NHS and society as whole of undiagnosed and diagnosed coeliac disease is largely unquantified, and the costs and cost-effectiveness of screening and treatment have not been properly examined.
The main objective of this study is to quantify the volume, type and cost of health care resources used by individuals diagnosed with coeliac disease in the 10-year period after and before diagnosis, and to compare these with costs incurred by a control group, using the General Practice Research Database (GPRD). The main focus of the study is on number and costs of primary care consultations, tests, referrals and prescriptions. We look at data for the period June 1987 to October 2005.
The study population is people in the GPRD who have a recorded diagnosis of coeliac disease. We define incident cases as people with a date of diagnosis of coeliac disease at least 12 months after their up-to-standard record on the GPRD begins. People with recorded diagnosis of coeliac disease made before their up-to-standard record begins are classified as prevalent cases. Controls are only be drawn from up-to-standard data.
We calculate a health care cost per person per year before and after diagnosis of coeliac disease, and compare this with the health care cost per patient per year amongst the controls. Unit costs for consultations, tests, outpatient referrals and prescriptions are obtained from Unit Costs of Health and Social Care (PSSRU, Kent), NHS reference costs, the British National Formulary and other published sources as appropriate. These are then combined with volume measures derived from the GPRD to produce a cost per patient per year, by category of resource use and in total. All costs are reported in 2009/10 UK pound sterling (£).
Our results show that average annual healthcare costs per patient increased by £310 (95% CI £299, £320) after diagnosis. CD cases experienced higher healthcare costs than controls both before diagnosis (mean difference £91; 95% CI: £86, £97) and after diagnosis (mean difference £354; 95% CI: £347, £361). These differences were driven mainly by higher test and referral costs before diagnosis, and by increased prescription costs after diagnosis.
This study shows significant additional primary care costs associated with coeliac disease. It provides novel evidence that will assist researchers evaluating interventions in this area, and will challenge policymakers, clinicians, researchers and the public to develop strategies that maximise the health benefits of the resources associated with this disease.
Violato, M, Gray, A, Papanicolas, I, and Ouellet, M (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. doi:10.1371/journal.pone.0041308.
Gray, AM and 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 Serv Res, 10:105.