Mountain Rachael, Kim Dexter, Johnson Kate M
Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences (Mountain, Johnson), University of British Columbia, Vancouver, BC; Centre for Health Informatics, Computing, and Statistics (Mountain), Lancaster Medical School, Lancaster University, Lancaster, UK; Faculty of Medicine (Kim) and Division of Respiratory Medicine, Department of Medicine (Johnson), University of British Columbia, Vancouver, BC.
Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences (Mountain, Johnson), University of British Columbia, Vancouver, BC; Centre for Health Informatics, Computing, and Statistics (Mountain), Lancaster Medical School, Lancaster University, Lancaster, UK; Faculty of Medicine (Kim) and Division of Respiratory Medicine, Department of Medicine (Johnson), University of British Columbia, Vancouver, BC
CMAJ Open. 2023 Nov 7;11(6):E1048-E1058. doi: 10.9778/cmajo.20230023. Print 2023 Nov-Dec.
An estimated 70% of Canadians with chronic obstructive pulmonary disease (COPD) have not received a diagnosis, creating a barrier to early intervention, and there is growing interest in the value of primary care-based opportunistic case detection for COPD. We sought to build on a previous cost-effectiveness analysis by evaluating the budget impact of adopting COPD case detection in the Canadian general population.
We used a validated discrete-event microsimulation model of COPD in the Canadian general population aged 40 years and older to assess the costs of implementing 8 primary care-based case detection strategies over 5 years (2022-2026) from the health care payer perspective. Strategies varied in eligibility criteria (based on age, symptoms or smoking history) and testing technology (COPD Diagnostic Questionnaire [CDQ] or screening spirometry). Costs were determined from Canadian studies and converted to 2021 Canadian dollars. Key parameters were varied in one-way sensitivity analysis.
All strategies resulted in higher total costs compared with routine diagnosis. The most cost-effective scenario (the CDQ for all patients) had an associated total budget expansion of $423 million, with administering case detection and subsequent diagnostic spirometry accounting for 86% of costs. This strategy increased the proportion of individuals diagnosed with COPD from 30.4% to 37.8%, and resulted in 4.6 million referrals to diagnostic spirometry. Results were most sensitive to uptake in primary care.
Adopting a national COPD case detection program would be an effective method for increasing diagnosis of COPD, dependent on successful uptake. However, it will require prioritisation by budget holders and substantial additional investment to improve access to diagnostic spirometry.
据估计，70%的加拿大慢性阻塞性肺疾病（COPD）患者尚未得到诊断，这为早期干预造成了障碍，并且基于初级保健的COPD机会性病例检测的价值受到越来越多的关注。我们试图在前一项成本效益分析的基础上，评估在加拿大普通人群中采用COPD病例检测的预算影响。
我们使用了一个经过验证的针对40岁及以上加拿大普通人群的COPD离散事件微观模拟模型，从医疗保健支付方的角度评估在5年（2022 - 2026年）内实施8种基于初级保健的病例检测策略的成本。这些策略在 eligibility criteria（基于年龄、症状或吸烟史）和检测技术（COPD诊断问卷[CDQ]或筛查肺功能测定）方面有所不同。成本根据加拿大的研究确定，并换算为2021年加拿大元。在单因素敏感性分析中对关键参数进行了变化。
与常规诊断相比，所有策略都导致总成本更高。最具成本效益的方案（对所有患者使用CDQ）相关的总预算增加了4.23亿加元，其中实施病例检测和后续诊断性肺功能测定占成本的86%。该策略将被诊断为COPD的个体比例从30.4%提高到37.8%，并导致460万次转诊进行诊断性肺功能测定。结果对初级保健中的采用率最为敏感。
采用全国性的COPD病例检测计划将是增加COPD诊断的有效方法，但取决于能否成功采用。然而，这将需要预算持有者进行优先排序，并进行大量额外投资以改善诊断性肺功能测定的可及性。
