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Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care
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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, K. K., Fitzmaurice, David A. and Jowett, Sue (2019) Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care. Thorax, 74 (8). pp. 730-739. doi:10.1136/thoraxjnl-2018-212148 ISSN 0040-6376.
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Official URL: http://dx.doi.org/10.1136/thoraxjnl-2018-212148
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.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Lungs -- Diseases, Obstructive -- Treatment -- Cost effectiveness, Medical economics, Lungs -- Diseases, Obstructive | ||||||||
| Journal or Publication Title: | Thorax | ||||||||
| Publisher: | BMJ | ||||||||
| ISSN: | 0040-6376 | ||||||||
| Official Date: | 15 July 2019 | ||||||||
| Dates: |
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| Volume: | 74 | ||||||||
| Number: | 8 | ||||||||
| Page Range: | pp. 730-739 | ||||||||
| DOI: | 10.1136/thoraxjnl-2018-212148 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 5 August 2019 | ||||||||
| Date of first compliant Open Access: | 12 August 2019 | ||||||||
| RIOXX Funder/Project Grant: |
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