Cost-effectiveness of screening for chronic obstructive pulmonary disease: a systematic review and meta-analysis

We aimed to synthesize the current evidence on cost-effectiveness of screening for Chronic Obstructive Pulmonary Disease (COPD) and to meta-analyse the incremental cost effectiveness ratios (ICER) to quantify the economic value of different COPD screening strategies on COPD development.

We searched for publications in MEDLINE (via PubMed), EMBASE, Web of Science and Cochrane Library databases, until December 2024, without any restriction of countries or article type. ICER were retrieved and meta-analysis based on DerSimonian and Laird method was applied to pool ICER across studies.

Of 1,108 originally retrieved papers, 12 articles fulfilled all search criteria which encompassed in total, 1,082,021 participants. Random effects meta-analysis revealed that the pooled ICER obtained from studies that used questionnaires for COPD screening against studies that did not perform any screening was $899.5 (95%CI [-1,903.9, 3,702.9]). The pooled ICER obtained from studies that used spirometry for COPD screening against studies that did not perform any screening was $521.3 (95%CI [116.0, 926.7]). When the analysis was based on studies that evaluated ICERs of the combination of spirometry testing plus questionnaires against no screening for COPD it was observed that the pooled ICER $15,305.8 (95%CI [5,364.2, 25,247.4]).

Despite variations in screening methods, the findings from this meta-analysis suggest that implementing COPD screening in primary care is cost-effective. It is recommended that policymakers prioritize screening for high-risk groups such as smokers and the elderly, and choose appropriate tools based on local economic conditions.