Celiac Disease,Osteoporosis and Screening

Stenson et al writing in the Feb. 28, 2005 Archives of Internal Medicine report the results from screening women for celiac disease (CD) in the Washington University bone health tertiary referral center. Finding a prevalence of 3.4 %, they recommend screening osteoporosis patients with two sensitive and specific blood tests (anti-TTG and anti-EMA). The women in the Wash.U.group underwent diagnostic endoscopy to confirm the diagnosis.The companion editorial suggests that if both tests are positive perhaps the endoscopy could be avoided.Cost considerations then become mandatory when screening for anything is at issue.
Dr.Bauchman in his editorial proceeds though the usual protocol of estimating the number of patients with a given condition who would need to be screened, the cost of screening all of them and the cost in this instance to prevent a fracture.We are told it would cost 2 billion dollars to screen the osteoporotic population.
The cost of the two blood tests are about $200.The 2 billion figure is what the Medical Czar of a country would consider. But then we have no medical czar and the relevant number is really the cost of screening for a given patient.The real life questions becomes will " insurance pay for it" and if not would the patient be willing to pay the money herself and will the physician be sued for missing a diagnosis if he does not test. Publications seem to always discuss these matters in global terms when maybe the locus of interest should be the individual doctor-patient interaction and relevant factors in that transaction.