Department of Pulmonary and Critical Care Medicine, Fengning Manchu Autonomous County Hospital of Chengde medical college, Chengde, China.
Institute of Chinese Medical Sciences, University of Macau, Macau Special Administrative Region, China.
Ann Palliat Med. 2021 Apr;10(4):4652-4660. doi: 10.21037/apm-21-812.
Early diagnosis and treatment of chronic obstructive pulmonary disease (COPD) can improve pulmonary function and reduce the incidence of exacerbations of acute COPD, thereby improving the patient's quality of life. In China, due to limited medical resources, COPD patients often cannot be diagnosed and treated early, so the benefits of early screening of patients with COPD high risk still lack effective supporting data.
Based on the data collected through the "Dual-lung screening initiative" performed by the Datan Health Center in Fengning Manchu Autonomous County on July 12 and July 19, 2020, the patients with COPD high risk who underwent early COPD screening were evaluated. The screened patients were mainly smokers aged over 45 and those with long-term exposure to secondhand smoke, underlying lung diseases, a family history of lung diseases, or respiratory symptoms. After filling out the COPD-population screener (COPD-PS) questionnaire, those who had a score of above 5 were subjected to the portable pulmonary function test. Subjects with a forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio <0.7 were diagnosed with COPD. A cost-effectiveness analysis model was applied to assess the screening's economic efficiency. The model was constructed through a combination of a decision tree and a Markov model, which enabled the simulation of the disease progression of COPD high risk patients under the condition of being screened or not being screened, to evaluate the incremental cost-effectiveness ratio between the two conditions.
A total of 700 questionnaires were issued for screening and 379 questionnaires were valid, and 92 patients were diagnosed with COPD (24.27%). The modeling results showed that among patients with COPD high risk, those receiving early screening had an increase in quality-adjusted life years (QALYs) by 0.28 units over those who did not, and a cost of 6,366.19 Renminbi (RMB) would be needed, which was much lower than the set willingness-to-pay threshold (70,888.99 RMB) [an equivalent of the 2019 per capita gross domestic product (GDP)].
For COPD high risk patients, receiving early screening has a cost-effective advantage over no screening. Therefore, early screening should be vigorously promoted to COPD high risk patients.
早期诊断和治疗慢性阻塞性肺疾病（COPD）可以改善肺功能，降低急性 COPD 加重的发生率，从而提高患者的生活质量。在中国，由于医疗资源有限，COPD 患者往往不能得到早期诊断和治疗，因此 COPD 高危人群早期筛查的获益仍缺乏有效的支持数据。
基于 2020 年 7 月 12 日和 7 月 19 日在丰宁满族自治县大数据中心开展的“双肺筛查计划”所收集的数据，对接受早期 COPD 筛查的 COPD 高危人群进行评估。筛查对象主要为年龄 45 岁以上的吸烟者和长期接触二手烟者、有基础肺部疾病、有肺部疾病家族史或有呼吸系统症状者。填写 COPD 人群筛查问卷（COPD-PS）后，得分高于 5 分者进行便携式肺功能检查。用力呼气量/用力肺活量（FEV1/FVC）比值<0.7 者诊断为 COPD。采用成本效益分析模型评估筛查的经济效益。该模型通过决策树和 Markov 模型相结合构建，能够模拟 COPD 高危人群在筛查和不筛查两种情况下的疾病进展情况，评估两种情况下的增量成本效益比。
共发放 700 份筛查问卷，有效问卷 379 份，诊断出 COPD 患者 92 例（24.27%）。建模结果显示，在 COPD 高危人群中，早期筛查组的质量调整生命年（QALY）比未筛查组增加了 0.28 个单位，而成本仅为 6366.19 元，远低于设定的意愿支付阈值（70888.99 元）[相当于 2019 年人均国内生产总值（GDP）]。
对于 COPD 高危人群，早期筛查比不筛查具有成本效益优势。因此，应大力向 COPD 高危人群推广早期筛查。
