The economic effects of screening for obstructive airway disease: an economic analysis of the DIMCA program

A large, population-based intervention (the DIMCA study) has shown substantial underdiagnosis of chronic obstructive pulmonary disease and asthma. Detection of undiagnosed patients by means of screening and subsequent monitoring was relatively inexpensive per detected patient, compared with other mass screening programs. The objectives of this study were to assess whether early detection according to the DIMCA protocol leads to increased utilization of health care resources and cost, other than the cost of the scheduled visits.

In a prospective randomized consent trial, the utilization of health care resources and cost were ascertained in two groups: a screened group (n = 416) and a control group (n = 462). In a subsample of 100 screened subjects, consultation frequency before screening was compared with the frequency after screening. Subjects were a random sample from the general population of between 25 and 70 years of age.

During an average follow-up of 3.6 years, there were no significant differences in health care resource utilization and cost between the screened subjects and the controls. Resource utilization before screening was not significantly different from resource utilization after screening. Statistically significant differences were found within the screened group: subjects with a positive screening result (i.e., with signs or symptoms of obstructive airway disease) consulted their general practitioners 3.7 times more frequently (P = 0.001) for respiratory reasons than subjects with a negative screening result. The total health care cost due to respiratory disease in screen-positive subjects was 6.4 times higher (P = 0.008).

There were no indications that screening for obstructive airway disease led to increased cost, above that of average care.