PT  - JOURNAL ARTICLE
AU  - Tosin Lambe
AU  - Peymane Adab
AU  - Rachel E Jordan
AU  - Alice Sitch
AU  - Alex Enocson
AU  - Kate Jolly
AU  - Jen Marsh
AU  - Richard Riley
AU  - Martin Miller
AU  - Brendan G Cooper
AU  - Alice Margaret Turner
AU  - Jon G Ayres
AU  - Robert Stockley
AU  - Sheila Greenfield
AU  - Stanley Siebert
AU  - Amanda Daley
AU  - KK Cheng
AU  - David Fitzmaurice
AU  - Sue Jowett
TI  - Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care
AID  - 10.1136/thoraxjnl-2018-212148
DP  - 2019 Aug 01
TA  - Thorax
PG  - 730--739
VI  - 74
IP  - 8
4099  - http://thorax.bmj.com/content/74/8/730.short
4100  - http://thorax.bmj.com/content/74/8/730.full
SO  - Thorax2019 Aug 01; 74
AB  - 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.