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

Background: Despite the considerable health impact of coeliac disease (CD), reliable estimates of the impact of diagnosis on health care use and costs are lacking. Aims: To 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. Methods: A 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. Results: Average annual healthcare costs per patient increased by 310 pound (95% CI 299 pound, 320) pound after diagnosis. CD cases experienced higher healthcare costs than controls both before diagnosis (mean difference 91; pound 95% CI: 86 pound, 97) pound and after diagnosis (mean difference 354; pound 95% CI: 347 pound, 361) pound. These differences were driven mainly by higher test and referral costs before diagnosis, and by increased prescription costs after diagnosis. Conclusions: This 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.