Assessing the Cost-Effectiveness of Reducing Acute Exacerbations in Patients with COPD

OBJECTIVES: Swallowing impairment is further complicated by rapid breathing in people with Chronic Obstructive pulmonary Disease (COPD). This dysphagia increases the risk of aspiration pneumonia and acute exacerbations of COPD. We designed an economic model to assess the cost-effectiveness of the Swallowing and Respiratory Sensation Assessment (SwaRSA) and a modelled rehabilitation intervention to reduce COPD exacerbations.

METHODS: The SwaRSA model employed a time horizon of one year and was conducted from the Australian payer perspective. The following four tests were assessed relative to a standard of care arm of no testing: EAT-10 score, swallowing capacity of liquids, tongue strength assessment, and respiratory sensation assessment in people with moderate to severe COPD. Model inputs such as costs, test sensitivities and specificities, COPD exacerbations risks, the efficacy of the swallowing rehabilitation intervention, and exacerbation-related utilities were derived from published sources.

RESULTS: Relative to no SwaRSA, three individual testing strategies were found to be cost-effective at incremental cost effectiveness ratio (ICER) ranging from $ 27,000 to 37,000 AUD assuming a willingness to pay of $ 50,000 AUD. The EAT-10 and the tongue strength were the two dominant options on the cost-effectiveness frontier. Model results were robust to variations in one-way sensitivity and probabilistic sensitivity analyses.

CONCLUSIONS: In patients with COPD, SwaRSA testing and subsequent intervention appears cost-effective relative to no SwaRSA screening.