NPJ primary care respiratory medicine · 2026
Cost-effectiveness of targeted COPD case-finding with the PUMA questionnaire followed by spirometry among ever-smokers in Singapore.
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Ooi Irene Li Peng, Qin Vicky Mengqi, Lee Eng Sing, Tan Kenneth, Tan Geak Poh, Manski-Nankervis Jo-Anne, Saxena Akshar
Аннотация
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is frequently undiagnosed among ever-smokers. We evaluated the cost-effectiveness of targeted COPD case-finding using the PUMA questionnaire followed by spirometry among ever-smokers aged 50 years and older in Singapore.
METHODS: A cohort Markov model compared two strategies: PUMA-based case-finding (PUMA score ≥4) followed by spirometry versus no case-finding, over a lifetime horizon from the healthcare payer perspective, with 3% annual discounting. A willingness-to-pay threshold of SGD75,000/QALY was applied.
RESULTS: Case-finding yielded an incremental cost of SGD 2,475 and an incremental gain of 0.0339 QALYs per person (ICER: SGD 73,065/QALY). Probabilistic sensitivity analysis indicated a 71.1% probability of being cost-effective at SGD 75,000/QALY. The ICER was most sensitive to the odds ratio of exacerbation for individuals with mild and moderate COPD treated with Long-Acting Muscarinic Antagonist (LAMA), and the severity distribution of undiagnosed COPD.
CONCLUSIONS: PUMA-based targeted COPD case-finding followed by spirometry is likely to be cost-effective at Singapore's willingness-to-pay threshold.
METHODS: A cohort Markov model compared two strategies: PUMA-based case-finding (PUMA score ≥4) followed by spirometry versus no case-finding, over a lifetime horizon from the healthcare payer perspective, with 3% annual discounting. A willingness-to-pay threshold of SGD75,000/QALY was applied.
RESULTS: Case-finding yielded an incremental cost of SGD 2,475 and an incremental gain of 0.0339 QALYs per person (ICER: SGD 73,065/QALY). Probabilistic sensitivity analysis indicated a 71.1% probability of being cost-effective at SGD 75,000/QALY. The ICER was most sensitive to the odds ratio of exacerbation for individuals with mild and moderate COPD treated with Long-Acting Muscarinic Antagonist (LAMA), and the severity distribution of undiagnosed COPD.
CONCLUSIONS: PUMA-based targeted COPD case-finding followed by spirometry is likely to be cost-effective at Singapore's willingness-to-pay threshold.