Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care

Abstract

INTRODUCTION
'One-off' systematic case-finding for COPD using a respiratory screening questionnaire is more effective and cost-effective than routine care at identifying new cases. However, it is not known whether early diagnosis and treatment is beneficial in the longer term. We estimated the long-term cost-effectiveness of a regular case-finding programme in primary care.

METHODS: A Markov decision analytic model was developed to compare the cost-effectiveness of a 3-yearly systematic case-finding programme targeted to ever smokers aged =50 years with the current routine diagnostic process in UK primary care. Patient-level data on case-finding pathways was obtained from a large randomised controlled trial. Information on the natural history of COPD and treatment effects was obtained from a linked COPD cohort, UK primary care database and published literature. The discounted lifetime cost per quality-adjusted life-year (QALY) gained was calculated from a health service perspective.

RESULTS: The incremental cost-effectiveness ratio of systematic case-finding versus current care was £16 596 per additional QALY gained, with a 78% probability of cost-effectiveness at a £20 000 per QALY willingness-to-pay threshold. The base case result was robust to multiple one-way sensitivity analyses. The main drivers were response rate to the initial screening questionnaire and attendance rate for the confirmatory spirometry test.

DISCUSSION: Regular systematic case-finding for COPD using a screening questionnaire in primary care is likely to be cost-effective in the long-term despite uncertainties in treatment effectiveness. Further knowledge of the natural history of case-found patients and the effectiveness of their management will improve confidence to implement such an approach.

Citation

(2019). Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care. Thorax, 730 -739. https://doi.org/10.1136/thoraxjnl-2018-212148

• Acceptance Date: Apr 1, 2019
• Publication Date: Jul 8, 2019
• Journal: Thorax
• Print ISSN: 0040-6376
• Publisher: BMJ Publishing Group
• Pages: 730 -739
• DOI: https://doi.org/10.1136/thoraxjnl-2018-212148
• Keywords: COPD, case-finding, early diagnosis, cost-effectiveness, markov model
• Publisher URL: http://dx.doi.org/10.1136/thoraxjnl-2018-212148