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Original article
Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care
  1. Tosin Lambe1,
  2. Peymane Adab2,
  3. Rachel E Jordan2,
  4. Alice Sitch2,
  5. Alex Enocson2,
  6. Kate Jolly2,
  7. Jen Marsh2,
  8. Richard Riley3,
  9. Martin Miller4,5,
  10. Brendan G Cooper6,
  11. Alice Margaret Turner7,
  12. Jon G Ayres8,
  13. Robert Stockley9,
  14. Sheila Greenfield2,
  15. Stanley Siebert10,
  16. Amanda Daley2,
  17. KK Cheng2,
  18. David Fitzmaurice2,
  19. Sue Jowett1
  1. 1 Health Economics Unit, University of Birmingham, Birmingham, UK
  2. 2 Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
  3. 3 Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
  4. 4 Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, West Midlands, UK
  5. 5 Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
  6. 6 Lung Investigation Unit, University Hospital Birmingham, Birmingham, UK
  7. 7 School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, Birmingham, UK
  8. 8 Institute of Occupational and Environmental Med, University of Birmingham, Birmingham, UK
  9. 9 Queen Elizabeth Hospital, Birmingham, UK
  10. 10 Birmingham Business School, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Sue Jowett, Health Economics Unit, University of Birmingham, Birmingham B15 2TT, UK; s.jowett{at}bham.ac.uk

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.

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

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Contributors TL built the model, conducted the economic analysis and wrote the paper with guidance from SJ, REJ and PA. SJ designed the health economic analyses for the TargetCOPD trial, supervised the economic modelling and contributed to writing the paper. PA and REJ identified the need for the TargetCOPD trial, co-led the running of the trial, provided guidance on the input parameters for the model and contributed to writing the paper. DF provided a primary care perspective and supported enrolment of practices for the trial. KKC contributed to refining the TargetCOPD trial design that generated data for parameter inputs. AS undertook the statistical analyses with guidance and input from RR and JM. AE, REJ, PA and DF oversaw the TargetCOPD trial. AMT provided clinical expertise related to model data inputs. KJ, MRM, BGC and RS provided expert guidance on the natural history of COPD, spirometry training/quality and model pathways. PA, REJ, DF, JGA, KKC, SJ, KJ, RR, MM, BGC, RS, SG, SS, AD and JM as the original coinvestigator team had input in the study set up. All authors had input into the analysis and interpretation of the model and edited the manuscript.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR, or the Department of Health.

  • Competing interests KKC reports grants from Pfizer China, outside of the submitted work. RS reports personal fees from Boehringer Ingelheim, personal fees from GSK, personal fees from Chiesi, personal fees from Takeda, personal fees from Novartis, personal fees from Polyphor, grants from CSL Behring, grants from Talecris, and personal fees from Dyax, outside of the submitted work. AMT reports grants from Linde REAL fund, grants from Alpha 1 Foundation, non-financial support from GSK, non-financial support from Boehringer Ingelheim, personal fees and non-financial support from Chiesi and personal fees and non-financial support from AZ, outside of the submitted work. SJ, PA, REJ, KKC, MM KJ, RR, DF, SS, AD, BGC, RS, JGA and SG report grants from NIHR, during the conduct of the study. Other authors declare no competing interests.

  • Patient consent for publication Not Required

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

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