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Screening for celiac disease in asymptomatic children with Down syndrome: cost-effectiveness of preventing lymphoma.
- Source :
-
Pediatrics [Pediatrics] 2006 Aug; Vol. 118 (2), pp. 594-602. - Publication Year :
- 2006
-
Abstract
- Background: Studies demonstrate an increased prevalence of celiac disease in persons with Down syndrome, leading some organizations and authors to recommend universal screening of children with Down syndrome. However, many children with Down syndrome are asymptomatic, and the long-term implications of screening are unknown. The complication of celiac disease that leads to mortality in the general population is non-Hodgkin's lymphomas.<br />Objectives: The purpose of this research in asymptomatic children with Down syndrome was to (1) calculate the number needed to screen to prevent a single case of lymphoma and (2) present a cost-effectiveness study of screening.<br />Methods: We constructed a decision tree using probabilities derived from the published literature for Down syndrome or from the general population where Down syndrome-specific data were not available. Celiac disease was determined by serologic screening and confirmation with intestinal biopsy. Sensitivity analysis was used to alter probability estimates affecting the cost of preventing lymphoma.<br />Results: Using our baseline values, the no-screen strategy is dominant; that is, screening not only costs more but also results in fewer quality-adjusted life-years. A screening strategy costs more than $500,000 per life-year gained. Screening all asymptomatic children with Down syndrome for celiac disease costs almost $5 million to prevent a single case of lymphoma.<br />Conclusion: These analyses do not support the cost-effectiveness of screening, and more data are needed before recommendations to screen asymptomatic children with Down syndrome for celiac disease can be made.
- Subjects :
- Celiac Disease complications
Celiac Disease economics
Celiac Disease epidemiology
Child
Comorbidity
Cost-Benefit Analysis
Costs and Cost Analysis
Disease Susceptibility
Gastrointestinal Neoplasms economics
Gastrointestinal Neoplasms epidemiology
Gastrointestinal Neoplasms etiology
Gastrointestinal Neoplasms prevention & control
Humans
Insurance, Health, Reimbursement economics
Insurance, Health, Reimbursement statistics & numerical data
Lymphoma, Non-Hodgkin economics
Lymphoma, Non-Hodgkin epidemiology
Lymphoma, Non-Hodgkin etiology
Medicaid economics
Medicaid statistics & numerical data
Medicare economics
Medicare statistics & numerical data
Models, Theoretical
Prevalence
Quality-Adjusted Life Years
Risk
Sensitivity and Specificity
Celiac Disease diagnosis
Decision Trees
Down Syndrome complications
Lymphoma, Non-Hodgkin prevention & control
Mass Screening economics
Subjects
Details
- Language :
- English
- ISSN :
- 1098-4275
- Volume :
- 118
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 16882812
- Full Text :
- https://doi.org/10.1542/peds.2005-2123