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 these strategies, eligible patients (based on age, smoking history, or symptoms) received 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 received 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 2019 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 gained. In the most efficient scenario, all patients aged ≥ 40 years received the CDQ at 3-year intervals. This scenario was associated with an incremental cost of $287 and incremental effectiveness of 0.015 QALYs per eligible patient over the 20-year time horizon, resulting in an ICER of $19,632/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.

中文翻译：

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早期发现 COPD 病例检测策略的成本效益

目标

早期发现和治疗慢性阻塞性肺疾病 (COPD) 的价值目前尚不清楚。我们评估了基于初级保健的 COPD 病例检测策略的成本效益。

方法

之前经过验证的加拿大 COPD 患者一般人群的离散事件模拟模型用于评估 16 种病例检测策略的成本效益。在这些策略中，符合条件的患者（根据年龄、吸烟史或症状）在常规访问初级保健医生期间每隔 3 年或 5 年接受一次 COPD 诊断问卷 (CDQ) 或筛查肺活量测定法。新诊断的患者接受戒烟治疗和基于指南的吸入器药物治疗。从医疗保健支付方的角度，对 20 年的时间范围进行了分析。费用以 2019 年加元 ($) 为单位。在单向敏感性分析中，关键的治疗参数是不同的。

结果

与无病例检测相比，所有 16 种病例检测方案的增量成本效益比 (ICER) 均低于 50,000 美元/获得的 QALY。在最有效的情况下，所有年龄≥ 40 岁的患者每 3 年接受一次 CDQ。这种情况与 287 美元的增量成本和 20 年时间范围内每位符合条件的患者 0.015 QALY 的增量有效性相关，与未检测到病例相比，ICER 为 19,632 美元/QALY。结果对治疗对新诊断患者症状的影响最为敏感。

结论

如果遵守治疗的最佳实践建议，以初级保健为基础的 COPD 病例检测计划可能具有成本效益，这可以减轻新诊断患者的症状。