OBJECTIVES : The value of early detection and treatment of chronic obstructive pulmonary disease (COPD) is currently unknown. We assessed the cost-effectiveness of various primary care-based case detection strategies for COPD.

METHODS : A previously validated discrete event simulation model of the general population of COPD patients in Canada was used to assess the cost-effectiveness of 16 case detection scenarios. In these scenarios, eligible patients (based on age, smoking history, or symptoms) received the COPD Diagnostic Questionnaire (CDQ) or screening spirometry, at 3- or 5-year intervals, during routine visits to a primary care physician. Newly diagnosed patients received treatment for smoking cessation and guideline-based inhaler pharmacotherapy. Analyses were conducted over a 20-year time horizon from the healthcare payer perspective. Costs are reported in 2015 Canadian dollars ($). Key treatment parameters were varied in one-way sensitivity analysis.

RESULTS : Compared to no case detection, all 16 case detection scenarios had an incremental cost effectiveness ratio (ICER) below a $50,000/QALY willingness to pay threshold in the reference case analysis. In the most efficient scenario, all patients ≥40 years received the CDQ at 3-year intervals. This scenario was associated with an incremental cost of $180 per eligible patient, and an incremental effectiveness of 0.009 QALYs per eligible patient, resulting in an ICER of $21,108/QALY compared to the CDQ delivered to ever smokers at 5-year intervals, which was the next most highly-ranked scenario on the efficiency frontier. Results were most sensitive to the impact of treatment on the symptoms of newly diagnosed patients. When this was not associated with a utility benefit, case detection was no longer cost-effective.

CONCLUSIONS : Primary care-based case detection programs for COPD are likely to be cost-effective if adherence to best-practice recommendations for treatment is high.