A gluten-free diet is the only treatment for celiac disease and adhering to this diet is challenging, argue gastroenterology experts. The average cost of gluten-free products are three to four times the price of
standard equivalent products, and there is limited availability of such
products in shops.
In The BMJ
, experts debate whether gluten-free prescriptions for people with celiac disease should be removed.
‘Targeting gluten-free food prescriptions may reduce costs in the short term but there will be long term costs in terms of patient outcomes, warned experts.’
Removing prescriptions for gluten-free products unfairly
discriminates against people with celiac disease, argue
gastroenterology experts David Sanders and Matthew Kurien, and Sarah
Sleet, Chief Executive of Coeliac UK.
They explain the NHS is facing unprecedented financial pressures,
and gluten-free food prescriptions might seem like an easy target for
clinical commissioning groups (CCGs) trying to make savings.
However, annual prescriptions costs for gluten-free foods were
£25.7m in England last year - just 0.3% of the total NHS prescribing
The National Institute for Health and Care Excellence's quality
standards for celiac disease highlight the role of prescriptions to
ensure that the diet is affordable and accessible for all patients.
Despite this, around 40% of CCGs in England are restricting or
removing these prescriptions, while Scotland, Wales, and Northern
Ireland are not following suit.
The experts say there is no other example in the NHS of a disease
having its treatment costs cut by 50-100%, and ask if CCGs would
consider this if the treatment for celiac disease were an
immunosuppressive drug and not food?
The alternative gluten free products being suggested by CCGs contain
nutritional deficiencies - an isocalorific portion of rice contains 90%
less iron and 82% less calcium than bread.
They warn that "targeting gluten-free food prescriptions may reduce
costs in the short term but there will be long term costs in terms of
On the other hand, James Cave, a general practitioner, argues that
"it's ludicrous for the NHS to be treating a food product as a drug and
to require GPs and pharmacists to behave as grocers."
He says the "complex rules" imposed by the NHS governing what can be
prescribed and how often are stressful for people with coeliac disease
and their GPs.
"It's a time-consuming rigmarole and, for the NHS, a very expensive one," he argues.
"The eight basic gluten-free staples advised for people with coeliac
disease are all cheaper from a supermarket than the NHS price," he
explains. "This is a scandal."
The NHS pays up to £6.73 for 500g of pasta, yet 500g of gluten free
pasta will cost £1.20 at a supermarket. Additionally, there is a
dispensing fee which is charged on top of all prescriptions.
"If we stopped prescribing gluten-free products tomorrow GPs would
shout for joy and the NHS would stop being ripped off," he says.
He suggests an alternative would be a national voucher scheme or a
personalized health budget for patients so they receive the difference
between the cost of gluten free products and the prescription.
"This could be funded from the money saved by no longer paying for
overpriced NHS gluten-free food," he says, and "the price of gluten-free
food might fall further once proper market forces were in play."
"Most importantly, people with celiac disease who currently
struggle with the logistics of a lifelong gluten-free diet and a
cumbersome and antiquated supply system, would have the convenience and
choice we all enjoy," he concludes.