# Quality of Life and Societal Costs Related to Celiac Disease Before and After Diagnosis

## TL;DR

This study shows that celiac disease patients experience improved quality of life and reduced costs after diagnosis, except for those diagnosed in childhood.

## Contribution

The study provides detailed evidence on how quality of life and societal costs change after celiac disease diagnosis.

## Key findings

- Quality of life improved significantly after celiac disease diagnosis, especially for those diagnosed in childhood.
- Health care and societal costs decreased by 23% and 36%, respectively, after diagnosis.
- Nonadherence to a gluten-free diet and comorbidities were linked to lower postdiagnosis quality of life.

## Abstract

Celiac disease (CD) may affect quality of life (QoL), health care use, and societal costs in various ways both before and after diagnosis. However, detailed evidence remains limited about how costs and QoL change after diagnosis and which patient characteristics (e.g., symptom duration) influence those changes. The aim of this study was to evaluate CD patients' QoL and societal costs before and after diagnosis.

In this cross-sectional study, 2,691 patient-members of the Dutch Celiac Society completed a questionnaire about their life before and after diagnosis. Data collection included sociodemographic and clinical characteristics, health care use, non–health care costs, and QoL (measured using the EuroQol 5-Dimension 5-Level). Mean QoL and annual health care and societal costs were compared prediagnosis and postdiagnosis. Multivariate regression models were used to identify factors associated with QoL and costs in both periods (and difference between periods).

On average, respondents recalled experiencing 4–5 symptoms before diagnosis. QoL improved significantly postdiagnosis, with greater improvements among childhood diagnoses. Annual health care and societal costs decreased by 23% and 36%, respectively, postdiagnosis, except for societal costs in those diagnosed during childhood. Age at diagnosis and the number of prediagnosis symptoms were associated with lower and higher recalled prediagnosis QoL, respectively. Number of symptoms, comorbidities, and nonadherence to a gluten-free diet were associated with lower postdiagnosis QoL.

After CD diagnosis, QoL significantly improved and health care and societal costs decreased, except for societal costs among childhood diagnoses. These findings enhance the understanding of CD's burden and economic impact, supporting health care and policy efforts for timely CD identification.