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

Research output: Contribution to journalArticle

Colleges, School and Institutes

External organisations

  • Research Institute of Primary Care and Health Sciences
  • Keele University
  • University Hospitals Birmingham NHS Trust

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.

Bibliographic note

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

Details

Original languageEnglish
Pages (from-to)730-739
Number of pages10
JournalThorax
Volume74
Early online date8 Jul 2019
Publication statusE-pub ahead of print - 8 Jul 2019

Keywords

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

ASJC Scopus subject areas