OBJECTIVES: Celiac Disease (CD) is an immune-mediated systemic disorder, common worldwide, caused by the ingestion of gluten in genetically-predisposed people. Low awareness of CD often leads to delays in diagnosis, which adds to medical costs because unrecognized CD is associated with excessive consumption of healthcare services and on-demand medications. This study has assessed the diagnostic yield and cost consequences of 2 strategies of pediatric CD in primary care: screening regardless of symptoms using a point-of-care test (POCT) for the detection versus case finding (CF).

METHODS: Children who went to their family pediatrician were offered POCT for anti-transglutaminase immunoglobulin A antibodies. Immediately after the test, but before knowing the results, a systematic search for one or more symptoms or conditions associated with higher risk for CD was performed. All POCT-positive subjects and those who were symptomatic at CF were referred to the CD Centers for disease confirmation. The costs of examinations and diagnostic and laboratory tests were estimated with regional outpatient tariffs (Sicily), and a price of €2.50 was used for each POCT. Two sensitivity analyses were performed, using ±20% of POCT price and a pediatrician visit cost of €15.31.

RESULTS: POCT was offered to 3,358 children. This screening detected 16 new cases of CD; CF detected 5 new cases of CD, but all of these had positive POCT. In the base case, total costs and mean cost per CD patient detected were €10,932.83 and €683.30 for screening strategy with POCT, and €3,953.90 and €790.78 for CF, respectively. In both sensitivity analyses, POCT was less costly than CF.

CONCLUSIONS: The results of our study suggest that mass screening may bridge the diagnostic gap for CD in children. The analysis has shown that POCT is more effective and less costly, for CD patient identified, than CF strategy.