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首页> 外文期刊>Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association >Cost-effectiveness of universal serologic screening to prevent nontraumatic hip and vertebral fractures in patients with celiac disease.
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Cost-effectiveness of universal serologic screening to prevent nontraumatic hip and vertebral fractures in patients with celiac disease.

机译：普遍性血清学筛查预防腹腔疾病患者非创伤性髋和椎骨骨折的成本效益。

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Patients with asymptomatic or poorly managed celiac disease can experience bone loss, placing them at risk for hip and vertebral fractures. We analyzed the cost-effectiveness of universal serologic screening (USS) vs symptomatic at-risk screening (SAS) strategies for celiac disease because of the risk of nontraumatic hip and vertebral fractures if untreated or undiagnosed.We developed a lifetime Markov model of the screening strategies, each with male or female cohorts of 1000 patients who were 12 years old when screening began. We screened serum samples for levels of immunoglobulin A, compared with tissue transglutaminase and total immunoglobulin A, and findings were confirmed by mucosal biopsy. Transition probabilities and quality of life estimates were obtained from the literature. We used generalizable cost estimates and Medicare reimbursement rates and ran deterministic and probabilistic sensitivity analyses.For men, the average lifetime costs were $8532 and $8472 for USS and SAS strategies, respectively, corresponding to average quality-adjusted life year gains of 25.511 and 25.515. Similarly for women, costs were $11,383 and $11,328 for USS and SAS strategies, respectively, corresponding to quality-adjusted life year gains of 25.74 and 25.75. Compared with the current standard of care (SAS), USS produced higher average lifetime costs and lower quality of life for each sex. Deterministic and probabilistic sensitivity analyses showed that the model was robust to realistic changes in all the variables, making USS cost-ineffective on the basis of these outcomes.USS and SAS are similar in lifetime costs and quality of life, although the current SAS strategy was overall more cost-effective in preventing bone loss and fractures among patients with undiagnosed or subclinical disease. On the basis of best available supportive evidence, it is more cost-effective to maintain the standard celiac screening practices, although future robust population-based evidence in other health outcomes could be leveraged to reevaluate current screening guidelines.
机译：无症状或管理不善的腹腔疾病患者可能会出现骨质流失，使他们面临髋部和椎骨骨折的风险。由于未经治疗或未经诊断的非创伤性髋部和椎骨骨折的风险，我们分析了针对腹腔疾病的通用血清学筛查（USS）与有症状风险筛查（SAS）策略的成本效益，并开发了终生马尔可夫筛查模型开始筛选时，每组有1000名年龄在12岁以下的男性或女性患者。与组织转谷氨酰胺酶和总免疫球蛋白A相比，我们筛选了血清样品中的免疫球蛋白A水平，并通过粘膜活检证实了发现。过渡概率和生活质量估计是从文献中获得的。我们使用可概括的成本估算和Medicare报销率，并进行了确定性和概率敏感性分析，对于男性，USS和SAS策略的平均终身成本分别为8532美元和8472美元，对应于经质量调整后的生命年的平均收益为25.511和25.515。同样，对于女性而言，USS和SAS策略的成本分别为11383美元和11328美元，这与质量调整后的生命年收益分别为25.74和25.75相对应。与当前的护理标准（SAS）相比，USS产生了更高的平均寿命成本，并且降低了男女的生活质量。确定性和概率敏感性分析表明，该模型对所有变量的现实变化均具有较强的鲁棒性，因此基于这些结果，USS成本无效.USS和SAS在生命周期成本和生活质量上相似，尽管当前的SAS策略是总体而言，在未诊断或亚临床疾病的患者中，预防骨丢失和骨折更具成本效益。根据最佳的现有支持证据，维持标准的腹腔筛查方法更具成本效益，尽管将来可以利用其他健康结局中基于人群的有力证据来重新评估当前的筛查指南。

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