THE UNIVERSITY OF BRITISH COLUMBIA
Objectives: The value of early detection and treatment of chronic obstructive pulmonary disease (COPD) is currently unknown. We assessed the cost-effectiveness of primary care-based case detection strategies for COPD.
Methods: A previously validated discrete event simulation model of the general population of COPD patients in Canada was used to assess the cost-effectiveness of 16 case detection strategies. In such strategies, eligible patients (based on age, smoking history, or symptoms) would receive the COPD Diagnostic Questionnaire (CDQ) or screening spirometry, at 3- or 5-year intervals, during routine visits to a primary care physician. Newly diagnosed patients would receive treatment for smoking cessation and guideline-based inhaler pharmacotherapy. Analyses were conducted over a 20-year time horizon from the healthcare payer perspective. Costs are in 2015 Canadian dollars ($). Key treatment parameters were varied in one-way sensitivity analysis.
Results: Compared to no case detection, all 16 case detection scenarios had an incremental cost-effectiveness ratio (ICER) below $50,000/QALY. In the most efficient scenario, all patients ≥40 years would receive the CDQ at 3-year intervals. This scenario was associated with an incremental cost of $180 and incremental effectiveness of 0.009 QALYs per eligible patient over the 20-year time horizon, resulting in an ICER of $18,791/QALY compared to no case detection. Results were most sensitive to the impact of treatment on the symptoms of newly diagnosed patients.
Conclusions: Primary care-based case detection programs for COPD are likely to be cost-effective if there is adherence to best-practice recommendations for treatment, which can alleviate symptoms in newly diagnosed patients.