Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care. Issue 8 (8th July 2019)

• Record Type: Journal Article
• Authors: Lambe, Tosin; Adab, Peymane; Jordan, Rachel E; Sitch, Alice; Enocson, Alex; Jolly, Kate; Marsh, Jen; Riley, Richard; Miller, Martin; Cooper, Brendan G; Turner, Alice Margaret; Ayres, Jon G; Stockley, Robert; Greenfield, Sheila; Siebert, Stanley; Daley, Amanda; Cheng, KK; Fitzmaurice, David; Jowett, Sue
• Is Part Of: Thorax. Volume 74:Issue 8(2019)
• Page Start: 730
• Page End: 739
• Publication Date: 2019-07-08
• Subjects: COPD -- markov model -- case-finding -- early diagnosis, cost-effectiveness; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2018-212148
• Languages: English
• ISSNs: 0040-6376

Abstract

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.