PRS17 COST-EFFECTIVENESS OF CASE DETECTION STRATEGIES FOR THE EARLY DETECTION OF COPD

Abstract

The value of early detection and treatment of chronic obstructive pulmonary disease (COPD) is currently unknown. We assessed the cost-effectiveness of various primary care-based case detection strategies for COPD. 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 scenarios. In these scenarios, 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 reported in 2015 Canadian dollars ($). Key treatment parameters were varied in one-way sensitivity analysis. Compared to no case detection, all 16 case detection scenarios had an incremental cost effectiveness ratio (ICER) below a $50,000/QALY willingness to pay threshold in the reference case analysis. In the most efficient scenario, all patients ≥40 years received the CDQ at 3-year intervals. This scenario was associated with an incremental cost of $180 per eligible patient, and an incremental effectiveness of 0.009 QALYs per eligible patient, resulting in an ICER of $21,108/QALY compared to the CDQ delivered to ever smokers at 5-year intervals, which was the next most highly-ranked scenario on the efficiency frontier. were most sensitive to the impact of treatment on the symptoms of newly diagnosed patients. When this was not associated with a utility benefit, case detection was no longer cost-effective. Primary care-based case detection programs for COPD are likely to be cost-effective if adherence to best-practice recommendations for treatment is high.