TY - JOUR

T1 - Budget impact analysis of adopting primary care-based COPD case detection in the Canadian general population

AU - Mountain, Rachael

AU - Johnson, Kate

PY - 2023/6/10

Y1 - 2023/6/10

N2 - ObjectivesAn estimated 70% of Canadians with chronic obstructive pulmonary disease (COPD) remain undiagnosed, representing a critical barrier to early intervention to improve disease outcomes. Emerging evidence suggests that opportunistic primary-care based case detection for COPD is a cost-effective solution. We built on a previous cost-effectiveness analysis by evaluating the budget impact of adopting a case detection programme in the general Canadian population.MethodsThis study accords with ISPOR best practice guidelines for budget impact analysis. We used a validated whole disease microsimulation model of COPD in the general Canadian population to evaluate eight case detection strategies implemented during routine primary care visits, varying in their patient eligibility criteria and testing technology. We assessed COPD-related healthcare costs from the healthcare payer perspective over a five-year time horizon (2022-2026) with gradual programme uptake from 5% to 25% by 2026. Costs were determined from Canadian studies and updated to 2021 Canadian dollars. Key parameters were varied in one-way sensitivity analysis.ResultsCompared to no case detection, all strategies resulted in substantial budget expansion. In the most cost-effective scenario at a willingness-to-pay of $50,000/QALY (questionnaire-based testing for all patients ≥40 years), total additional costs were $427 million over five years, with 86% of costs attributed to administering case detection and subsequent diagnostic testing. Furthermore, there were 4.6 million referrals to diagnostic spirometry, 96% of which were false positives. The proportion of individuals with COPD who were diagnosed increased from 30.4% to 37.8% by 2026. Results were most sensitive to case detection uptake in primary care.ConclusionsA national primary care-based COPD detection programme will require prioritisation by budget holders and significant additional investment in the availability of diagnostic spirometry. Case detection could be effective for reducing the burden of undiagnosed COPD but will depend on successful uptake of the programme in primary care.

AB - ObjectivesAn estimated 70% of Canadians with chronic obstructive pulmonary disease (COPD) remain undiagnosed, representing a critical barrier to early intervention to improve disease outcomes. Emerging evidence suggests that opportunistic primary-care based case detection for COPD is a cost-effective solution. We built on a previous cost-effectiveness analysis by evaluating the budget impact of adopting a case detection programme in the general Canadian population.MethodsThis study accords with ISPOR best practice guidelines for budget impact analysis. We used a validated whole disease microsimulation model of COPD in the general Canadian population to evaluate eight case detection strategies implemented during routine primary care visits, varying in their patient eligibility criteria and testing technology. We assessed COPD-related healthcare costs from the healthcare payer perspective over a five-year time horizon (2022-2026) with gradual programme uptake from 5% to 25% by 2026. Costs were determined from Canadian studies and updated to 2021 Canadian dollars. Key parameters were varied in one-way sensitivity analysis.ResultsCompared to no case detection, all strategies resulted in substantial budget expansion. In the most cost-effective scenario at a willingness-to-pay of $50,000/QALY (questionnaire-based testing for all patients ≥40 years), total additional costs were $427 million over five years, with 86% of costs attributed to administering case detection and subsequent diagnostic testing. Furthermore, there were 4.6 million referrals to diagnostic spirometry, 96% of which were false positives. The proportion of individuals with COPD who were diagnosed increased from 30.4% to 37.8% by 2026. Results were most sensitive to case detection uptake in primary care.ConclusionsA national primary care-based COPD detection programme will require prioritisation by budget holders and significant additional investment in the availability of diagnostic spirometry. Case detection could be effective for reducing the burden of undiagnosed COPD but will depend on successful uptake of the programme in primary care.

U2 - 10.1016/j.jval.2023.03.064

DO - 10.1016/j.jval.2023.03.064

M3 - Meeting abstract

VL - 26

SP - S12

JO - Value in Health

JF - Value in Health

SN - 1098-3015

IS - 6 Supplement

M1 - P53

T2 - ISPOR 2023

Y2 - 7 May 2023 through 10 May 2023

ER -