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

ESRC：瑞切尔·芒廷：ES/P000665/1慢性阻塞性肺疾病（COPD）是一种进行性和使人衰弱的疾病，由于呼吸问题影响患者参与日常活动的能力。COPD是全球发病率和死亡率的主要原因，其患病率只会随着人口老龄化而增加。早期诊断和治疗对减缓肺功能下降和症状进展至关重要。然而，据估计，70%的加拿大COPD患者目前未被诊断，三分之一的COPD患者在病情加重后最初在医院诊断。有一个明确的需要，以改善抢先体验照顾作为一个晚诊断可能会浪费机会的干预，特别是戒烟，并增加昂贵的住院治疗的可能性。在初级保健设置的情况下检测策略提供了一个潜在的解决方案，诊断不足的COPD的问题。病例检测指的是在常规医疗保健接触中针对疑似高风险人群进行诊断检测。在设计病例检测策略时，需要考虑许多变量，包括合格标准、招募策略和检测技术的选择。在医疗预算面临巨大压力的时期，需要对改善患者护理的策略进行严格评估，以最大限度地提高服务和护理提供的价值。最近的成本效益研究发现，根据筛查问卷的结果将患者转诊进行诊断检测的策略可改善患者的长期结局，并且可能具有成本效益。然而，实施病例检测战略将对加拿大的医疗保健预算产生重大影响，研究尚未考虑负担能力。拟议的研究项目将通过评估在加拿大普通人群中采用基于初级保健的COPD病例检测策略的预算影响来扩展先前的成本效益分析。在通过成本效益分析确定医疗干预的价值后，预算影响分析解决了政策采纳的可负担性问题。该项目将复制成本效益分析中使用的策略，并纳入当地医疗保健决策者关于预算限制的额外信息，以确定为拟议病例检测策略提供资金的总成本。考虑到目标人群的规模（整个加拿大）的假设是，与成本效益分析相比，预算影响分析将导致选择更具限制性的情景。BIA将使用COPD评估平台（EPIC）进行，EPIC是最近开发的模拟COPD整个疾病途径的模型，从发病到死亡，在加拿大普通人群中的个体水平。决策模拟模型对于预算分配决策和设计有效的医疗保健政策来说是一种越来越有价值的工具，因为它们允许研究人员整合多个证据来源，在更长的时间内进行预测，并在评估中提供更大的灵活性。EPIC旨在评估医疗保健政策变化的影响，是加拿大唯一的COPD模型。不列颠哥伦比亚省卫生部的决策者已将改善COPD早期护理和治疗的可及性确定为战略优先事项，并将参与该分析的开发和输出。因此，这些结果有真实的潜力影响当地政策和围绕COPD早期检测的资金决策。

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.