目的:乳糜泻(CD)是一种常见但未被诊断的自身免疫性疾病,具有实质性的长期后果。在青少年初级保健中心(YHCC)进行的CD抗体的高精度护理点测试(POCT)可能有助于早期识别CD,但是缺乏有关此类策略的成本效益的证据。与荷兰的临床检测相比,我们估计了主动病例发现和大规模筛查的长期成本效益。
方法:根据每种策略,使用决策树和马尔可夫模型来模拟一组3岁的CD儿童,考虑到它们对长期成本(从社会角度)和质量调整寿命年(QALY)的影响。模型参数包含来自GLUTENSCREEN项目的数据,荷兰乳糜泻协会,荷兰儿科监测单位,和公布的来源。主要结果是策略之间的增量成本效益比(ICER)。
结果:与目前的护理相比,大规模筛查产生的QALYs增加了7.46,费用增加了28,635欧元(ICER:€3841/QALY),与目前的护理相比,病例发现产生的QALYs增加了4.33,费用增加了15,585欧元(ICER:3603欧元/QALY)。在愿意为每个QALY支付2万欧元的情况下,与目前的治疗方案相比,两种治疗方案均具有很高的成本效益.情景分析表明,大规模筛查可能是最佳策略,除非假设在检测无症状病例中没有益处。
结论:在使用POCT的儿童中通过筛查或病例发现较早地识别CD可以改善健康结果,并且与目前的护理相比具有长期的成本效益。如果拟议战略的可行性和可接受性是成功的,需要在荷兰实施定期护理。
OBJECTIVE: Celiac disease (CD) is a common yet underdiagnosed autoimmune disease with substantial long-term consequences. High-accuracy point-of-care tests for CD antibodies conducted at youth primary health care centers may enable earlier identification of CD, but evidence about the cost-effectiveness of such strategies is lacking. We estimated the long-term cost-effectiveness of active case finding and mass screening compared with clinical detection in the Netherlands.
METHODS: A decision tree and Markov model were used to simulate a cohort of 3-year-old children with CD according to each strategy, taking into account their impact on long-term costs (from a societal perspective) and quality-adjusted life-years (QALYs). Model parameters incorporated data from the GLUTENSCREEN project, the Dutch Celiac Society, the Dutch Pediatric Surveillance Unit, and published sources. The primary outcome was the incremental cost-effectiveness ratio (ICER) between strategies.
RESULTS: Mass-screening produced 7.46 more QALYs and was €28,635 more costly compared with current care (ICER: €3841 per QALY), and case finding produced 4.33 more QALYs and was €15,585 more costly compared with current care (ICER: €3603 per QALY). At a willingness to pay of €20,000 per QALY, both strategies were highly cost-effective compared with current care. Scenario analyses indicated that mass screening is likely the optimal strategy, unless no benefit in detecting asymptomatic cases is assumed.
CONCLUSIONS: An earlier identification of CD through screening or case finding in children using a point-of-care tests leads to improved health outcomes and is cost-effective in the long-term compared with current care. If the feasibility and acceptability of the proposed strategies are successful, implementation in Dutch regular care is needed.