Lambe, T, Adab, P, Jordan, RE, Sitch, A, Enocson, A, Jolly, K, Marsh, J, Riley, R ORCID: https://orcid.org/0000-0001-8699-0735, Miller, M, Cooper, BG, Turner, AM, Ayres, JG, Stockley, R, Greenfield, S, Siebert, S, Daley, A, Cheng, KK, Fitzmaurice, D and Jowett, S (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
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via BMJ Publishing Group at http://dx.doi.org/10.1136/thoraxjnl-2018-212148 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: COPD, case-finding, early diagnosis, cost-effectiveness, markov model
Subjects: R Medicine > RC Internal medicine > RC705 Diseases of the respiratory system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
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Depositing User: Symplectic
Date Deposited: 08 Aug 2019 09:44
Last Modified: 08 Aug 2019 09:49
URI: http://eprints.keele.ac.uk/id/eprint/6646

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