Chen Qiushi, Fan Yiwen, Huang Ke, Li Wei, Geldsetzer Pascal, Bärnighausen Till, Yang Ting, Wang Chen, Chen Simiao
The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA.
Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
Lancet Reg Health West Pac. 2024 Apr 29;46:101065. doi: 10.1016/j.lanwpc.2024.101065. eCollection 2024 May.
China has the highest disease burden of chronic obstructive pulmonary disease (COPD) in the world; however, the diagnosis rate remains low. Screening for COPD in the population may improve early diagnosis and long-term health outcomes for patients with COPD. In this study, we aimed to evaluate the cost-effectiveness of population-based COPD screening policies in China.
We developed a microsimulation model that simulated incidence, natural history, and clinical management of COPD over a lifetime horizon among the general population aged 35-80 years in China. We evaluated population-based screening policies with different screening methods (one-step with COPD Screening Questionnaire or two-step with additional portable spirometer test) and frequencies (one-time or every 1-10 years). We calculated the incremental cost-effectiveness ratio (ICER) of the screening policies compared with the status quo (without screening) and identified the most cost-effective screening policy. Scenario and sensitivity analyses were performed to assess the impact of key parameters and the robustness of model results.
Compared with the status quo, all population-based COPD screening policies were cost-effective with estimated ICERs ranging between $8034 and $13,209 per quality-adjusted-life-year (QALY), all under the willingness-to-pay value of $38,441/QALY (three times China's gross domestic product per capita). A total of 0.39%-8.10% of COPD-related deaths and 0.58%-2.70% of COPD exacerbations were projected to be averted by COPD screening. Among all screening policies, annual two-step screening was the most cost-effective. Improving the linkage from screening to diagnosis and treatment could further increase population health benefits and the cost-effectiveness of COPD screening.
Population-based screening for COPD could be cost-effective in China. Offering public programs for COPD screening similar to existing preventive health services for other chronic diseases could be a promising strategy to improve population health outcomes and mitigate the disease burden of COPD in China.
Alexander von Humboldt Foundation, National Natural Science Foundation of China, CAMS Innovation Fund for Medical Science, Chinese Academy of Engineering project, and Horizon Europe.
中国是全球慢性阻塞性肺疾病（COPD）疾病负担最高的国家；然而，其诊断率仍然很低。在人群中筛查COPD可能会改善COPD患者的早期诊断和长期健康结局。在本研究中，我们旨在评估中国基于人群的COPD筛查政策的成本效益。
我们开发了一个微观模拟模型，该模型模拟了中国35至80岁普通人群一生中COPD的发病率、自然史和临床管理情况。我们评估了采用不同筛查方法（使用COPD筛查问卷一步法或额外进行便携式肺量计测试的两步法）和频率（一次性或每1至10年一次）的基于人群的筛查政策。我们计算了与现状（不进行筛查）相比筛查政策的增量成本效益比（ICER），并确定了最具成本效益的筛查政策。进行了情景分析和敏感性分析，以评估关键参数的影响和模型结果的稳健性。
与现状相比，所有基于人群的COPD筛查政策都具有成本效益，估计ICER在每质量调整生命年（QALY）8034美元至13209美元之间，均低于支付意愿值38441美元/QALY（中国人均国内生产总值的三倍）。预计COPD筛查可避免0.39%至8.10%的COPD相关死亡和0.58%至2.70%的COPD急性加重。在所有筛查政策中，每年进行两步筛查最具成本效益。改善筛查与诊断及治疗之间的联系可进一步增加人群健康效益和COPD筛查的成本效益。
在中国，基于人群的COPD筛查可能具有成本效益。提供类似于其他慢性病现有预防性健康服务的COPD筛查公共项目，可能是改善中国人群健康结局和减轻COPD疾病负担的一项有前景的策略。
亚历山大·冯·洪堡基金会、中国国家自然科学基金、中国医学科学院医学创新基金、中国工程院项目和欧洲地平线计划。
