Celiac disease (CD) has an estimated global prevalence of 1.4%.¹ Guidelines support testing symptomatic or high-risk individuals for CD with total immunoglobulin A (IgA) (to exclude deficiency) and tissue transglutaminase autoantibodies (tTG-IgA).² However, most cases remain undiagnosed due to unrecognizable symptoms or no known family history of CD.³ Since serial testing may be required over a child’s lifetime, initial human leukocyte antigen (HLA) determination followed by tTG-IgA testing in those with increased pretest probability could be cost-effective⁴ by limiting serologic screening to the 40% of the population with HLA risk.⁵ Although Italy recently passed a law mandating nationwide childhood screening for CD, the United States Preventive Services Task Force concluded that there was insufficient evidence to screen for asymptomatic CD. Although other countries have examined the cost-effectiveness of screening, such data are not yet available in the United States.⁶