Budget impact analysis of adopting primary care-based COPD case detection in the Canadian general population

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ESRC : Rachael Mountain : ES/P000665/1 Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating disease that impacts patients' ability to participate in everyday activities due to breathing problems. COPD is a leading cause of morbidity and mortality worldwide with the prevalence only set to increase with an aging population. Early diagnosis and treatment are important to slow lung function decline and the progression of symptoms. However, it is estimated that 70% of Canadians with COPD are currently undiagnosed and one-third of COPD patients are initially diagnosed in hospital following an exacerbation. There is a clear need to improve early access to care as a late diagnosis can waste opportunities for intervention, particularly smoking cessation, and increase the likelihood of costly hospitalisations.Case detection strategies in a primary care setting offer a potential solution to the problem of underdiagnosed COPD. Case detection refers to targeting groups who are suspected to be at high risk for diagnostic testing during routine healthcare encounters. There are many variables to consider when designing a case detection strategy including eligibility criteria, recruitment strategy, and choice of testing technology. In a time of intense pressure on healthcare budgets, rigorous assessments of strategies to improve patient care are needed to maximise the value of services and care delivery. Recent cost-effectiveness studies have found that a strategy in which patients are referred for diagnostic testing based on the results of a screening questionnaire improves long-term patient outcome and is likely to be cost effective. However, the implementation of a case detection strategy would have significant implications for Canada's healthcare budget and research is yet to consider affordability. The proposed research project will extend a previous cost-effectiveness analysis by evaluating the budget impact of adopting primary care-based COPD case detection strategies in the Canadian general population. After establishing the value of a healthcare intervention through a cost-effectiveness analysis, a budget impact analysis addresses the question of the affordability of policy adoption. This project will replicate the strategies used in the cost-effectiveness analysis and incorporate additional information on budget constraints from local healthcare decision makers to determine the total costs of funding the proposed case detection strategies. Given the size of the target population (the whole of Canada) the hypothesis is that the budget impact analysis will result in a more restrictive scenario being selected compared to the cost-effectiveness analysis.The BIA will be carried out using the Evaluation Platform in COPD (EPIC), a recently developed model that simulates the entire disease pathway for COPD, from incidence to death, at the individual-level in the Canadian general population. Decision simulation models are an increasingly valuable tool for budget allocation decisions and designing effective healthcare policies as they allow researchers to incorporate multiple sources of evidence, predict over longer time periods, and provide more flexibility in evaluations. EPIC was designed for the purpose of evaluating the impact of changes in healthcare policies and is the only model of its kind for COPD in Canada.Decision makers within the British Columbia Ministry of Health have identified improving access to early care and treatment for COPD as a strategic priority and will be engaged on the development and output of this analysis. Therefore, the results have real potential to impact local policy and funding decisions around early detection for COPD.