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Journals / Karadeniz Teknik Üniversitesi Sosyal Bilimler Enstitüsü Sosyal Bilimler Dergisi / 2026 / Cilt: 15 Sayı: 29

THE ECONOMIC BURDEN OF CELIAC DISEASE AND STATE FISCAL INTERVENTION TOOLS: GLOBAL EXPERIENCES AND RECOMMENDATIONS FOR TÜRKİYE

ÇÖLYAK HASTALIĞININ EKONOMİK YÜKÜ VE DEVLETİN MALİ MÜDAHALE ARAÇLARI: KÜRESEL DENEYİMLER VE TÜRKİYE İÇİN ÖNERİLER

Esra Berika Dönmez(ZONGULDAK BÜLENT ECEVİT ÜNİVERSİTESİ)0000-0002-6734-0937
Adem Demirbozan(ZONGULDAK BÜLENT ECEVİT ÜNİVERSİTESİ)0000-0003-0611-276X
Mehmet Avcı(ZONGULDAK BÜLENT ECEVİT ÜNİVERSİTESİ)0000-0002-5672-4142
Pages
178–199
Publication Date
2025-06-26
DOI
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

The findings indicate that financial support for celiac patients in Türkiye is not in line with current economic conditions and that more inclusive policy tools should be developed to alleviate their economic burden.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Celiac patients face both direct and indirect economic costs due to their lifelong requirement for a gluten-free diet.
📊
Key Findings & Data:Indirect costs, on the other hand, encompass labor force losses, decreased productivity, and social exclusion.
💡
Conclusion & Impact:The findings indicate that financial support for celiac patients in Türkiye is not in line with current economic conditions and that more inclusive policy tools should be developed to alleviate their economic burden.
🔬Design:Araştırma Makalesi
📍Scope:Comprehensive Sample
⚙️Variables:Çölyak Hastalığı · Ekonomik Maliyet · Devlet Müdahalesi

Abstract

Celiac patients face both direct and indirect economic costs due to their lifelong requirement for a gluten-free diet. Direct costs include the higher prices of gluten-free products compared to their regular counterparts, as well as healthcare expenses related to other diseases caused by celiac disease. Indirect costs, on the other hand, encompass labor force losses, decreased productivity, and social exclusion. This study examines various government interventions for celiac patients in different countries, such as fiscal support mechanisms, tax reductions, and subsidies. By comparing Türkiye’s existing support policies with these practices, shortcomings and areas for improvement have been identified. The findings indicate that financial support for celiac patients in Türkiye is not in line with current economic conditions and that more inclusive policy tools should be developed to alleviate their economic burden. Within the framework of the social state principle, this study aims to contribute to public finance and health economics by offering policy recommendations to reduce the economic burden on celiac patients.

Özet

Çölyak hastaları, hayat boyu glütensiz beslenme gereksinimleri nedeniyle doğrudan ve dolaylı ekonomik maliyetlerle karşı karşıya kalmaktadır. Doğrudan maliyetler arasında glüten içermeyen ürünlerin muadillerine göre yüksek fiyatları ve çölyak hastalığının neden olduğu diğer hastalıkla ilgili sağlık harcamaları yer alırken, dolaylı maliyetler iş gücü kaybı, üretkenlik azalması ve sosyal dışlanma gibi unsurları içermektedir. Çalışmada, farklı ülkelerde çölyak hastalarına yönelik mali destek mekanizmaları, vergi indirimleri ve sübvansiyonlar gibi devlet müdahaleleri incelenmiştir. Türkiye’deki destek politikaları bu uygulamalarla karşılaştırılarak eksiklikler ve iyileştirme alanları belirlenmiştir. Bulgular, Türkiye'de çölyak hastalarına yönelik mali desteklerin günün koşullarına uygun olmadığını ve ekonomik yükü hafifletmek için daha kapsayıcı politika araçlarının geliştirilmesi gerektiğini ortaya koymaktadır. Çalışma, sosyal devlet anlayışı çerçevesinde çölyak hastalarının ekonomik yükünü azaltmaya yönelik politika önerileri sunarak kamu maliyesi ve sağlık ekonomisi açısından katkı sağlamayı amaçlamaktadır.

🔖

Cite This Article

Dönmez, E. B., Demirbozan, A., Avcı, M. (2025). THE ECONOMIC BURDEN OF CELIAC DISEASE AND STATE FISCAL INTERVENTION TOOLS: GLOBAL EXPERIENCES AND RECOMMENDATIONS FOR TÜRKİYE. Karadeniz Teknik Üniversitesi Sosyal Bilimler Enstitüsü Sosyal Bilimler Dergisi, Cilt: 15 Sayı: 29, 178–199. https://ajindex.com/articles/1117012

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References (65)

  1. Abdulla, A. & Garemo, M. (2018). High cost of gluten free products might be challenging for people with celiac disease in the United Arab Emirates. International Journal of Celiac Disease, 6(2), 37-41.
  2. Agarwal, S., Prasad, S., Agarwal, A., Raja Ali, R. A., Leffler, D. A., Green, P. H. R., Sanders, D. S., Anderson, R. P., Ahuja, V., Mulder, C. J. J. & Makharia, G. K. (2025). Celiac disease care differs significantly between high and low-middle-income countries: A global survey of celiac experts from 63 countries. Journal of Gastroenterology and Hepatology, 40(1), 142–152. https://doi.org/10.1111/jgh.16793
  3. Arab News. (2022). Strict gluten-free diet prescription for managing celiac disease: Saudi consultant. https://arab.news/pkz6n, Erişim Tarihi: 30.12.2024.
  4. Arrow, K. J. (1963). Uncertainty and the welfare economics of medical care. American Economic Review, 53, 941-969.
  5. Associazione Italiana Celiachia. (t.y.). Esiste una norma che tutela il celiaco nelle mense pubbliche? https://www.celiachia.it/faq/esiste-una-norma-che-tutela-il-celiaco-nelle-mense-pubbliche/, Erişim Tarihi: 05.12.2024.
  6. Associazione Italiana Celiachia. (2024). Financial aid for celiac patients: Italian government offsets cost of gluten-free products. https://toscana.celiachia.it/celiacs-in-tuscany/blog-navigating-gluten-free-tuscany-2/financial-aid-for-celiac-patients/, Erişim Tarihi: 05.12.2024.
  7. Babio Sánchez, N., Lladó Bellette, N., Besora-Moreno, M., Castillejo, G., Guillén, N., Martínez-Cerezo, F., Viíchez, E., Roger, E. & Salas Salvadó, J. (2020). A comparison of the nutritional profile and price of gluten-free products and their gluten-containing counterparts available in the Spanish market. Nutrición Hospitalaria, 37(4), 814-822. https://doi.org/10.20960/nh.03016
  8. Barada, K., Abu Daya, H., Rostami, K. & Catassi, C. (2012). Celiac disease in the developing world. Gastrointestinal Endoscopy Clinics of North America, 22(4), 773-796. https://doi.org/10.1016/j.giec.2012.07.002
  9. Bozorg, S. R., Lee, A. R., Mårild, K. & Murray, J. A. (2024). The economic ıceberg of celiac disease: More than the cost of gluten-free food. Gastroenterology, 167(1), 172-182. https://doi.org/10.1053/j.gastro.2024.02.051
  10. Bozorg, S. R., Söderling, J., Everhov, Å. H., Lebwohl, B., Green, P. H. R., Neovius, M., Ludvigsson, J. F. & Mårild, K. (2022). Work loss in patients with celiac disease: A population-based longitudinal study. Clinical Gastroenterology and Hepatology, 20(5), 1068-1076.e6. https://doi.org/10.1016/j.cgh.2021.09.002
  11. Büyükşehir çölyak hastalarına derman olmaya devam ediyor. (2023, 28 Aralık). Antalya Büyükşehir Belediyesi. https://antalya.bel.tr/Haberler/HaberDetay/6563/buyuksehir-colyak-hastalarina-derman-olmaya-devam-ediyor, Erişim Tarihi: 10.03.2025.
  12. Büyükşehir’den çölyak hastalarına destek! (2025, 26 Şubat). Ege’de Son Söz. https://www.egedesonsoz.com/buyuksehirden-colyak-hastalarina-destek?utm, Erişim Tarihi: 10.03.2025.
  13. Caeiro, C., Pragosa, C., Cruz, M. C., Pereira, C. D. & Pereira, S. G. (2022). The role of pseudocereals in celiac disease: Reducing nutritional deficiencies to ımprove well-being and health. Journal of Nutrition and Metabolism, 2022(1), 1-8. https://doi.org/10.1155/2022/8502169
  14. Carande-Kulis, V. G., Getzen, T. E. & Thacker, S. B. (2007). public goods and externalities: A research agenda for public health economics. Journal of Public Health Management and Practice, 13(2), 227-232. https://doi.org/10.1097/00124784-200703000-00024
  15. Cataldo, F. & Montalto, G. (2007). Celiac disease in the developing countries: A new and challenging public health problem. World Journal of Gastroenterology, 13(15), 2153-2159. https://doi.org/10.3748/wjg.v13.i15.2153
  16. Catassi, C., Ratsch, Ii.-M., Gandolfi, L., Pratesi, R., Fabiani, E., Asmar, R. E., Frijia, M., Bearzi, I. & Vizzoni, L. (1999). Why is coeliac disease endemic in the people of the Sahara? The Lancet, 354(9179), 647-648. https://doi.org/10.1016/S0140-6736(99)02609-4
  17. Coeliac Society of Ireland. (2023). Financial Support. Get Financial Support. https://coeliac.ie/financial-support/, Erişim Tarihi: 10.12.2024.
  18. Coeliac UK. (2024). Prescriptions. https://www.coeliac.org.uk/information-and-support/coeliac-disease/once-diagnosed/prescriptions/, Erişim Tarihi: 10.12.2024.
  19. Commission Implementing Regulation (EU) No 828/2014. (2014, 30 Temmuz). https://eur-lex.europa.eu/eli/reg_impl/2014/828/oj/eng
  20. Cronin, C. C. & Shanahan, F. (2003). Exploring the iceberg the spectrum of celiac disease. Official Journal of the American College of Gastroenterology, 98(3), 518. https://doi.org/10.1111/j.1572-0241.2003.07308.x
  21. Çölyak hastalarına glütensiz gıda desteği. (t.y.). Bayrampaşa Belediyesi. https://bayrampasa.bel.tr/colyak-hastalarina-glutensiz-gida-destegi-5667, Erişim Tarihi: 10.03.2025.
  22. Çölyak hastalarına glütensiz gıda yardımı. (2023, 21 Kasım). Küçükçekmece Belediyesi. https://kucukcekmece.istanbul/icerikler/haberler/colyak-hastalarina-glutensiz-gida yardimi/35062, Erişim Tarihi: 10.03.2025.
  23. Çölyak hastalarına glütensiz gıda desteği. (t.y.). Sultangazi Belediyesi. https://www.sultangazi.bel.tr/news/detail/colyak-hastalarina-glutensiz-gida-destegi/214, Erişim Tarihi: 10.03.2025.
  24. Elli, L., Branchi, F., Tomba, C., Villalta, D., Norsa, L., Ferretti, F., Roncoroni, L. & Bardella, M. T. (2015). Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity. World Journal of Gastroenterology, 21(23), 7110-7119. https://doi.org/10.3748/wjg.v21.i23.7110
  25. Falcomer, A. L., Pratesi, C. B., Nakano, E. Y., Chaves, C., Rostami-Nejad, M., Guennouni, M., Aksan, A., Pouchot, J., Häuser, W. & Zandonadi, R. P. (2024). From struggle to strength: A multicentric study on how public policies for celiac disease transform lives. Nutrients, 16(17), 2855. https://doi.org/10.3390/nu16172855
  26. Fornari, E., Fornari, D., Grandi, S., Iuffmann Ghezzi, A. & Menegatti, M. (2021). Taking advantage of the gluten-free opportunity: Assortment as the key driver for modern grocery retailers. Journal of Retailing and Consumer Services, 63, 102747. https://doi.org/10.1016/j.jretconser.2021.102747
  27. Fry, L., Madden, A. M. & Fallaize, R. (2018). An investigation into the nutritional composition and cost of gluten‐free versus regular food products in the UK. Journal of Human Nutrition and Dietetics, 31(1), 108-120. https://doi.org/10.1111/jhn.12502
  28. García-Manzanares, Á. & Lucendo, A. J. (2011). Nutritional and dietary aspects of celiac disease. Nutrition in Clinical Practice, 26(2), 163-173. https://doi.org/10.1177/0884533611399773
  29. Gatti, S., Rubio-Tapia, A., Makharia, G. & Catassi, C. (2024). Patient and community health global burden in a world with more celiac disease. Gastroenterology, 167(1), 23-33. https://doi.org/10.1053/j.gastro.2024.01.035
  30. Gluten-Free QA (GFqa). (2024). Is celiac disease a disability? Your rights and benefits around the world. https://glutenfree.qa/is-celiac-disease-a-disability/, Erişim Tarihi: 13.12.2024.
  31. Gorgitano, M. T. & Sodano, V. (2019). Gluten-free products: From dietary necessity to premium price extraction tool. Nutrients, 11(9), 1997. https://doi.org/10.3390/nu11091997
  32. Grand View Research. (2022). Gluten-free products market size and share report, 2030. https://www.grandviewresearch.com/industry-analysis/gluten-free-products-market, Erişim Tarihi: 25.11.2024.
  33. Green, P. H. R. & Jabri, B. (2006). Celiac disease. Annual Review of Medicine, 57, 207-221. https://doi.org/10.1146/annurev.med.57.051804.122404
  34. Guandalini, S., Tundia, N., Thakkar, R., Macaulay, D., Essenmacher, K. & Fuldeore, M. (2016). Direct costs in patients with celiac disease in the USA: A retrospective claims analysis. Digestive Diseases and Sciences, 61(10), 2823-2830. https://doi.org/10.1007/s10620-016-4219-x
  35. Guennouni, M., Khoudri, N. E., Bourrouhouate, A. & Hilali, A. (2020). Availability and cost of gluten-free products in Moroccan supermarkets and e-commerce platforms. British Food Journal, 124(1), 1-13. https://doi.org/10.1108/BFJ-06-2019-0411
  36. Gülenay Sümer, S. A., Akbay Harmandar, F., Uyar, S. & Çeki̇n, A. H. (2015). Non-çölyak gluten duyarlılığı. Güncel Gastroentoloji, 19(2), 91-97.
  37. Güneş, S. (2022). Glütensiz Olamayacak Kadar İyi Yaşamın Peşinde (Birinci Basım). Nova Kitap.
  38. Hall, N. J., Rubin, G. & Charnock, A. (2009). Systematic review: Adherence to a gluten‐free diet in adult patients with coeliac disease. Alimentary Pharmacology & Therapeutics, 30(4), 315-330. https://doi.org/10.1111/j.1365-2036.2009.04053.x
  39. Kdz. Ereğli Belediyesi’nden çölyak hastalarına glütensiz gıda desteği. (2024, 05 Kasım). T.C. Karadeniz Ereğli Belediyesi. https://www.kdzeregli.bel.tr/yayin/2770-kdzeregli-belediyesinden-colyak-hastalarina-glutensiz-gida-destegi, Erişim Tarihi: 10.03.2025.
  40. King, J. A., Jeong, J., Underwood, F. E., Quan, J., Panaccione, N., Windsor, J. W., Coward, S., deBruyn, J., Ronksley, P. E., Shaheen, A.-A., Quan, H., Godley, J., Veldhuyzen van Zanten, S., Lebwohl, B., Ng, S. C., Ludvigsson, J. F. & Kaplan, G. G. (2020). Incidence of celiac disease is increasing over time: A systematic review and meta-analysis. Official Journal of the American College of Gastroenterology, 115(4), 507. https://doi.org/10.14309/ajg.0000000000000523
  41. Lambert, K. & Ficken, C. (2016). Cost and affordability of a nutritionally balanced gluten‐free diet: Is following a gluten‐free diet affordable? Nutrition & Dietetics, 73(1), 36-42. https://doi.org/10.1111/1747-0080.12171
  42. Lee, A. R., Ng, D. L., Zivin, J. & Green, P. H. R. (2007). Economic burden of a gluten‐free diet. Journal of Human Nutrition and Dietetics, 20(5), 423-430. https://doi.org/10.1111/j.1365-277X.2007.00763.x
  43. Lee, A. R., Wolf, R. L., Lebwohl, B., Ciaccio, E. J. & Green, P. H. R. (2019). Persistent economic burden of the gluten free diet. Nutrients, 11(2), 399. https://doi.org/10.3390/nu11020399
  44. Mårild, K., Söderling, J., Bozorg, S. R., Everhov, Å. H., Lebwohl, B., Green, P. H. R., Neovius, M., & Ludvigsson, J. F. (2020). Costs and use of health care in patients with celiac disease: A population-based longitudinal study. American Journal of Gastroenterology, 115(8), 1253-1263. https://doi.org/10.14309/ajg.0000000000000652
  45. Özkaya, Ş. Ö. & Özkaya, V. (2018). Çölyak hastalığına diyetetik yaklaşım. Selçuk Tıp Dergisi, 4(34), 186-193. https://doi.org/10.30733/std.2018.00906
  46. Padalino, L., Conte, A. & Del Nobile, M. (2016). Overview on the general approaches to improve gluten-free pasta and bread. Foods, 5(4), 87. https://doi.org/10.3390/foods5040087
  47. Panagiotou, S. & Kontogianni, M. D. (2017). The economic burden of gluten-free products and gluten-free diet: A cost estimation analysis in Greece. Journal of Human Nutrition and Dietetics, 30(6), 746-752. https://doi.org/10.1111/jhn.12477
  48. Pellegrini, N. & Agostoni, C. (2015). Nutritional aspects of gluten‐free products. Journal of the Science of Food and Agriculture, 95(12), 2380-2385. https://doi.org/10.1002/jsfa.7101
  49. Pinto-Sanchez, M. I., Verdu, E. F., Gordillo, M. C., Bai, J. C., Birch, S., Moayyedi, P. & Bercik, P. (2015). Tax-deductible provisions for gluten-free diet in Canada compared with systems for gluten-free diet coverage available in various countries. Canadian Journal of Gastroenterology and Hepatology, 29(2), 508156. https://doi.org/10.1155/2015/508156
  50. Regulation (EU) No 609/2013 of the European Parliament and of the Council. (2013, 12 Haziran). https://eur-lex.europa.eu/eli/reg/2013/609/oj/eng
  51. Regulation (EU) No 1169/2011 of the European Parliament and of the Council. (2011, 25 Ekim). https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A32011R1169
  52. Qashqari, L., Shakweer, D., Alzaben, A. S. & Hanbazaza, M. A. (2024). Investigation of cost and availability of gluten-free food in Jeddah, Ksa. Journal of Taibah University Medical Sciences, 19(2), 422-428. https://doi.org/10.1016/j.jtumed.2024.02.001
  53. Shah, S., Akbari, M., Vanga, R., Kelly, C. P., Hansen, J., Theethira, T., Tariq, S., Dennis, M. & Leffler, D. A. (2014). Patient perception of treatment burden is high in celiac disease compared with other common conditions. American Journal of Gastroenterology, 109(9), 1304-1311. https://doi.org/10.1038/ajg.2014.29
  54. Si̇ncan Beledi̇yesi̇’nden çölyaklı vatandaşlara nakdi̇ yardım. (2025, 9 Ocak). Sincan Belediyesi. https://www.sincan.bel.tr/haberler/sincan-belediyesinden-colyakli-vatandaslara-nakdi-yardim, Erişim Tarihi: 10.03.2025.
  55. Soler, L. & Borzykowski, N. (2021). The costs of celiac disease: A contingent valuation in Switzerland. The European Journal of Health Economics, 22(9), 1487-1505. https://doi.org/10.1007/s10198-021-01376-z
  56. Sosyal Güvenli̇k Kurumu Sağlık Uygulama Tebli̇ği̇. (2014, 10 Nisan). https://www.mevzuat.gov.tr/File/GeneratePdf?mevzuatNo=17229&mevzuatTur=Teblig&mevzuatTertip=5
  57. Stevens, L. & Rashid, M. (2008). Gluten-free and regular foods: A cost comparison. Canadian Journal of Dietetic Practice and Research, 69(3), 147-150. https://doi.org/10.3148/69.3.2008.147
  58. Sürmeli, N. & Karabudak, E. (2019). Çölyak olmayan gluten duyarlılığı. Beslenme ve Diyet Dergisi, 47(1), 66-72. https://doi.org/10.33076/2019.BDD.1202
  59. T.C. Sağlık Bakanlığı. (2024). Çölyak hastalığı farkındalık haftası. https://hsgm.saglik.gov.tr/tr/haberler-6/coelyak-hastaligi-farkindalik-haftasi.html, Erişim Tarihi: 13.02.2025.
  60. Thompson, T. & Simpson, S. (2015). A comparison of gluten levels in labeled gluten-free and certified gluten-free foods sold in the United States. European Journal of Clinical Nutrition, 69(2), 143-146. https://doi.org/10.1038/ejcn.2014.211
  61. Uğur, A. (2017). Public policies that can be implemented to struggle with celiac disease in Turkey. Journal of Economic and Social Thought, 4(4), Article 4. https://doi.org/10.1453/jest.v4i4.1509
  62. Wieser, H., Segura, V., Ruiz-Carnicer, Á., Sousa, C. & Comino, I. (2021). Food safety and cross-contamination of gluten-free products: A narrative review. Nutrients, 13(7), 2244. https://doi.org/10.3390/nu13072244
  63. World Population Review. (2024). Gluten intolerance by country 2024. https://worldpopulationreview.com/country-rankings/gluten-intolerance-by-country, Erişim Tarihi: 5.12.2024.
  64. Yıldırım, E. (2020). Çölyak Hastalığı ve Glutensiz Besleme. Genel Sağlık Bilimleri Dergisi, 2(3), 175-187.
  65. Cataldo, F. & Montalto, G. (2007). Celiac disease in the developing countries: A new and challenging public health problem. World Journal of Gastroenterology, 13(15), 2153-2159. https://doi.org/10.3748/wjg.v13.i15.2153