Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care.



Lambe, Tosin, Adab, Peymane, Jordan, Rachel E, Sitch, Alice ORCID: 0000-0001-7727-4497, Enocson, Alex, Jolly, Kate, Marsh, Jen, Riley, Richard, Miller, Martin, Cooper, Brendan G
et al (show 9 more authors) (2019) Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care. Thorax, 74 (8). 730 - 739.

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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: Article
Depositing User: Symplectic Admin
Date Deposited: 30 May 2019 10:25
Last Modified: 29 Nov 2019 11:27
DOI: 10.1136/thoraxjnl-2018-212148
URI: http://livrepository.liverpool.ac.uk/id/eprint/3042822
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