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

Tosin Lambe, Peymane Adab, Rachel Jordan, Alice Sitch, Alexandra Enocson, Kate Jolly, Jennifer Marsh, Richard D Riley, Martin Miller, Brendan G Cooper, Alice Turner, Jonathan Ayres, Robert A Stockley, Sheila Greenfield, Stanley Siebert, Amanda Daley, Kar Cheng, David Fitzmaurice, Sue Jowett

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
147 Downloads (Pure)

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.

Original languageEnglish
Pages (from-to)730-739
Number of pages10
JournalThorax
Volume74
Issue number8
Early online date8 Jul 2019
DOIs
Publication statusPublished - Aug 2019

Bibliographical note

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

Keywords

  • COPD
  • case-finding
  • early diagnosis, cost-effectiveness
  • markov model

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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