Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care
Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care
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DOI：
10.1136/thoraxjnl-2018-212148
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发表时间：
2019-08-01
期刊：
影响因子：
10
通讯作者：
Jowett, Sue
中科院分区：
文献类型：
--
作者：
Lambe, Tosin;Adab, Peymane;Jowett, Sue
引言在识别新病例方面，使用呼吸筛查问卷进行的COPD“一次性”系统病例发现比常规护理更有效且更具成本效益。然而，目前尚不清楚早期诊断和治疗是否有益于长期。我们估计的长期成本效益的定期病例发现计划在primary care.Methods马尔可夫决策分析模型的开发，以比较成本效益的3年一次的系统性病例发现计划，针对吸烟者年龄>= 50岁，目前的常规诊断过程中，在英国的初级保健。病例发现途径的患者水平数据来自一项大型随机对照试验。从相关COPD队列、英国初级保健数据库和已发表文献中获得COPD自然史和治疗效果的信息。贴现的终身成本每质量调整生命年（QALY）gainedfrom a health service perspective.Results的增量成本效益比的系统性病例发现与当前的护理是16磅596每额外的QALY gained，与78%的概率的成本效益在20磅000每QALY愿意支付阈值。基础病例结果对多个单向敏感性分析具有稳健性。的主要驱动因素是响应率的初步筛选问卷和出勤率的确认肺功能test.Discussion定期系统的情况下，发现慢性阻塞性肺病使用筛选问卷在初级保健可能是具有成本效益的长期治疗效果，尽管不确定性。进一步了解病例发现患者的自然病史及其管理的有效性将提高实施这种方法的信心。
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 pound 596 per additional QALY gained, with a 78% probability of cost-effectiveness at a 20 pound 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.