Review for 10.1186/s12876-021-01737-1 (2021)

Reviewer’s report
Title: 
Is mass screening for coeliac disease a wise use of resources? – A health economic evaluation
Version: 
1 
Date: 
13 Feb 2021
Reviewer's report:
This is a very well conducted and valuable study assessing the cost effectiveness of coeliac screening, and
the manuscript is well written, comprehensively covering many important points for discussion. I only
have a few minor comments:
1. Where did the sensitivities and specificities of the coeliac serology derive from? Were they based on
results from meta-analysis of the literature or local/national data? As we know, sensitivities of TTG/EMA
can vary quite widely depending on different assays and labs, and this can have a direct impact on the cost
of screening.
2. Can the authors comment on the general cost of gluten free diet compared to a normal diet in Sweden,
and whether the cost is covered by the health service? This could impact on the economic burden and
potentially the quality of life of screen detected asymptomatic patients. For example, in the UK, the cost of
a gluten free product is 3 times higher than an equivalent gluten containing product, and some areas in the
UK have reduced or stopped gluten free product prescriptions for patients with coeliac disease due to
reduced funding. This can have a direct effect on the quality of life and dietary adherence in these patients.
3. Can the authors quote any recent studies illustrating the time period of delay in diagnosis in Sweden?
The cost per QALY is based on many assumptions and one of them is the diagnostic delay time. These
information/assumptions allow the reader to make comparison to other populations.
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Is the study design appropriate to answer the research question (including the use of appropriate controls),
and are the conclusions supported by the evidence presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes