Elsevier

Preventive Medicine

Volume 30, Issue 4, April 2000, Pages 302-308
Preventive Medicine

Regular Article
The Economic Effects of Screening for Obstructive Airway Disease: An Economic Analysis of the DIMCA Program

https://doi.org/10.1006/pmed.2000.0633Get rights and content

Abstract

Background. 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.

Methods. 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.

Results. 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).

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

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Cited by (10)

  • Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial

    2016, The Lancet Respiratory Medicine
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    Finally, before a national case-finding programme can be recommended, the longer term effects of case finding on health outcomes should be studied. The DIMCA programme in the Netherlands suggested that long-term prognosis might not be improved by screening.24 It would be important to establish whether earlier identification by our approach would lead to effective management and health gains that would outweigh the cost to the health service of the medications and management and the potential cost to the patient of having a “label” of COPD.

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This study was financially supported by the Dutch Prevention Fund.

2

To whom reprint requests should be addressed at the Department of General Practice and Social Medicine, CARA Research Group, Code 229, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Fax: (+31) 243617084. E-mail: [email protected].

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