OBJECTIVES: Chronic obstructive pulmonary disease (COPD) imposes a substantial health burden in China, with a high prevalence and the majority of cases remaining undiagnosed, resulting in a barrier to early intervention. Population-based screening is a public health strategy that could potentially improve early diagnosis and long-term health outcomes. This study aims to assess the cost-effectiveness and budget impact of COPD screening policies in China.

METHODS: Building upon our previously validated microsimulation model for simulating the natural history and clinical management of COPD among general population aged 35–80 years in China, we incorporated transitions in smoking behaviors and generalized the simulation for an open cohort to consider incidents of COPD. The model was recalibrated to estimates of COPD burden and smoking prevalence in China. Two-step screening (questionnaire followed by portable spirometry) or one-step screening (questionnaire only) were evaluated as annual or biannual polices. We estimated the incremental cost-effectiveness ratio (ICER) and annual costs over six years (2025–2030) to assess the cost-effectiveness and budget impact of population-based COPD screening.

RESULTS: Compared with the status quo, all COPD screening policies were cost-effective under the willingness-to-pay threshold of three-time GDP per capita in China, with ICERs ranging from $22,922–$27,595 per QALY. The total budget increase was projected to range from $20.2–$39.8 trillion across different screening policies among 756 million eligible population during 2025–2030. Annual two-step screening was the most cost-effective policy; when budget is limited to $25 trillion, biannual two-step screening became the best alternative. Screening and diagnosis accounted for 20%–28% of budget increase, with the rest attributed to the increase in treatment costs.

CONCLUSIONS: Population-based screening for COPD, despite extra costs for healthcare payers and patients, could be cost-effective in China. Policymakers should consider integrating COPD screening into national public health programs, ensuring adequate funding to maximize economic and health benefits.