Is stratification testing for treatment of chronic obstructive pulmonary disease exacerbations cost-effective in primary care? An early cost-utility analysis

Journal article

Objectives: Patients with COPD who experience acute exacerbations usually require treatment with oral steroids or antibiotics, depending on the aetiology of the exacerbation. Current management is based on clinician’s assessment and judgement, which lacks diagnostic accuracy and results in overtreatment. A test to guide these decisions in primary care is in development. We developed an early decision model to evaluate the cost-effectiveness of this treatment stratification test in the primary care setting in the United Kingdom.

Methods: A combined decision tree and Markov model was developed of COPD progression and the exacerbation care pathway. Sensitivity analysis was carried out to guide technology development and inform evidence generation requirements.

Results: The base case test strategy cost GBP 423 (USD 542) less and resulted in a health gain of 0.15 quality-adjusted life years per patient compared with not testing. Testing reduced antibiotic prescriptions by 30%, potentially lowering the risk of antimicrobial resistance developing. In sensitivity analysis, the result depended on the clinical effects of treating patients according to the test result, as opposed to treating according to clinical judgement alone, for which there is limited evidence. The results were less sensitive to the accuracy of the test.

Conclusions: Testing may be cost-saving in primary care, but this requires robust evidence on whether test-guided treatment is effective. High quality evidence on the clinical utility of testing is required for early modelling of diagnostic tests generally.

Authors: Abel, L; Dakin, H; Roberts, N; Ashdown, H; Butler, C

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Cambridge University Press
• Journal: International Journal of Technology Assessment in Health Care
• Volume: 35
• Issue: 2
• Pages: 116-125
• Publication date: 2019-03-04
• Acceptance date: 2018-12-09
• DOI: 10.1017/S0266462318003707
• EISSN: 1471-6348
• ISSN: 0266-4623
• Keywords: cost-effectiveness; quality-adjusted life year; primary care; chronic obstructive pulmonary disease