Evaluation of the determinants of the cost overrun of the Gluten-Free Diet in celiac disease in Spain: analysis and intervention proposal

The aim of this paper is to analyze the determinants of the additional cost associated with celiac disease in Spain. This is achieved through an ad-hoc designed survey directed at members of the Federation of Celiac Associations of Spain (FACE) across various federations, examining different aspects of the current reality of the celiac community. The paper's added value lies in its specific focus on the Spanish context, an area with limited applied studies compared to other countries. By identifying the cost factors related to celiac disease, the research offers potential insights for public health policies. The survey provides a comprehensive understanding of the dietary habits and economic burden faced by individuals with celiac disease in Spain, contributing valuable data for improving dietary compliance and quality of life. The main results show that nearly half of the households indicated significant changes in consumption habits post-diagnosis, primarily consuming more specific gluten-free products and naturally gluten-free products. In Spain, FACE detected a 370% cost overrun for gluten-free products. Furthermore, households tend to spend quite a lot on these products, with higher expenditures associated with households having multiple celiac members, younger individuals, and those with persistent and intense symptoms. Neither gender nor population size significantly affected spending levels. However, household type, age, and income level did show significant associations. Surprisingly, income level did not linearly correlate with higher expenditures, indicating that celiac burden is relatively inelastic to income. Greater concern about long-term health and the presence of other diseases (not necessarily related to celiac disease) were linked to higher probability of spending more on gluten-free products. The paper recommends considering public subsidization of gluten-free products, similarly to other countries where individuals with celiac disease receive compensation through reimbursements or tax deductions, proposing a scoring system based on the results of our econometric analysis.