OBJECTIVES : This study aims to compare the cost-effectiveness of three chronic obstructive pulmonary disease (COPD) screening strategies, 1) portable spirometer, 2) questionnaire, and 3) no screening. The target population are Chinese chronic bronchitis patients who are not yet diagnosed as COPD.

METHODS : We developed a model in Microsoft Excel® to simulate the progression of the screening program, lung function capacity over time and the impact of the screening programs. The decision tree model simulated the three screening processes and calculated initial cohort for Markov. A Markov model simulated the disease progression with seven states (undiagnosed-mild, undiagnosed-moderate, undiagnosed-severe & very severe, diagnosed-mild, diagnosed-moderate, diagnosed-severe & very severe and death). Severity of COPD health state were defined based on the pulmonary function as measured by post-bronchodilator forced expiratory volume in 1-second (FEV₁) percentage of predicted normal value. The transition probabilities were based on the FEV₁ decline rate and local expert’s interview. Mortality was varied according to the disease severity and exacerbation status. Cost data of health services including spirometry screening and treatment costs covered both maintenance and exacerbation. We used life-time horizon and health care system perspective. Both quality-adjusted life year (QALY) and costs were discounted at a rate of 3.5%. Uncertainty was assessed by one-way and probabilistic sensitivity analysis.

RESULTS : Under the base case conditions, portable spirometer screening was cost-effective compared with questionnaire screening and no screening, with an incremental cost-effectiveness ratio (ICER) of CNY 1,828 and CNY 4,135 per QALY, respectively. Questionnaire screening was cost-effective compared with no screening, with an ICER of CNY 4,462 per QALY. Sensitivity analyses confirmed the robustness of the results.

CONCLUSIONS : Portable spirometer screening is likely the optimal option for COPD screening among high risk patients in China, followed by questionnaire screening. We will further investigate the application of the models on other at-high-risk populations.