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

Published online by Cambridge University Press:  04 March 2019

Lucy Abel
Affiliation:
Nuffield Department of Primary Care Health Sciences, University of Oxford
Helen A. Dakin
Affiliation:
Health Economics Research Centre, University of Oxford
Nia Roberts
Affiliation:
Bodleian Health Care Libraries, University of Oxford
Helen F. Ashdown
Affiliation:
Nuffield Department of Primary Care Health Sciences, University of Oxford
Chris C. Butler
Affiliation:
Nuffield Department of Primary Care Health Sciences, University of Oxford
Gail Hayward
Affiliation:
Nuffield Department of Primary Care Health Sciences, University of Oxford
Ann Van den Bruel
Affiliation:
Nuffield Department of Primary Care Health Sciences, University of Oxford
Philip J. Turner
Affiliation:
Nuffield Department of Primary Care Health Sciences, University of Oxford
Yaling Yang*
Affiliation:
Nuffield Department of Primary Care Health Sciences, University of Oxford
*
Author for correspondence: Yaling Yang, E-mail: yaling.yang@phc.ox.ac.uk
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Abstract

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Objectives

Patients with chronic obstructive pulmonary disease (COPD) who experience acute exacerbations usually require treatment with oral steroids or antibiotics, depending on the etiology 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 percent, 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 modeling of diagnostic tests generally.

Type
Assessment
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Cambridge University Press 2019

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