Resource Use and Costs Associated with Coeliac Disease before and after Diagnosis in 3,646 Cases: Results of a UK Primary Care Database Analysis

Abstract

BackgroundDespite the considerable health impact of coeliac disease (CD), reliable estimates of the impact of diagnosis on health care use and costs are lacking.AimsTo quantify the volume, type and costs, in a United Kingdom primary care setting, of healthcare resources used by individuals diagnosed with CD up to ten years before and after diagnosis, and to estimate medical costs associated with CD.MethodsA cohort of 3,646 CD cases and a parallel cohort of 32,973 matched controls, extracted from the General Practice Research Database (GPRD) over the period 1987–2005 were used i) to evaluate the impact of diagnosis on the average resource use and costs of cases; ii) to assess direct healthcare costs due to CD by comparing average resource use and costs incurred by cases vs. controls.ResultsAverage 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.ConclusionsThis 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.

Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England

“…CPRD records listing administrative staff, such as secretaries, IT staff, practice and fund managers and receptionists, were not counted as a clinical direct contact with the patient and were, therefore, excluded from the costs. Following a previous study, 142 we only counted one consultation per day if more than one was recorded per patient. Primary care contacts and tests were costed using unit costs from national cost databases (Table 17).…”

“…Following a previous study, 142 we counted only one consultation per day. Pharmaceuticals were costed using the number of prescriptions stratified by BNF code 90 per patient.…”

Methods for estimating costs in patients with hyperlipidemia experiencing their first cardiovascular event in the United Kingdom

“…Because of the low cost for simple, commonly used tests like lipid panels and complete blood counts, we elected to ignore these costs. However, others have included test costs, and the methods for these are provided in several studies 13,16 . They generally involve identifying the Read codes for relevant tests, and identifying the appropriate NHS cost for each.…”

“…As a result of these resources, a variety of studies have been conducted that estimate costs based on resource utilization derived from CPRD and HES data, many of which were published recently [7][8][9][10][11][12][13][14][15][16][17][18] . However, it is still challenging to understand the methods used, and to implement them in research 19 .…”

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“…Several studies demonstrated that gluten-free food is not always readily available, and it is considerably more expensive than regular, gluten-containing foods [8]. The increasing incidence of celiac disease in the population has negative effects not only on the quality of life but also on the health care system: it has been estimated that the average annual health care costs per-patient in primary care significantly increased by 91% for CD patients after they had been diagnosed with the disease [9]. The impact is also evident for the agricultural and food sectors: wheat is one of the first three cereals for diffusion and cultivation for human nutrition.…”