China county based COPD screening and cost-effectiveness analysis

Background: 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.Methods: 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.Results: 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 year (QALY)s 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)].Conclusions: 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.