The Cost-Effectiveness of a Questionnaire as a Screening
Test for Chronic Obstructive Pulmonary Disease among
the Bangkok Elderlyt
NANTA MARANETRA, MD, FRACP, FRCP*, BENJAMAS CHUAYCHOO, MD*,
JARIY A LERTAKYAMANEE, MD**, CHANA NARUMAN, MSc*,
NITIPATANA CHIERAKUL, MD*, WANCHAI DEJSOMRITRUTAI, MD, MSc*,
ARTH NANA, MD*, WISANU THAMLIKITKUL, MD***,
T ASNEEY A SUTHAMSMAI, MSc*, SUTEE SAENGKAEW, BN*,
WICHEAN SREELUM, Dip.MST*, MONTCHAI AKSORNIN, Dip.AN*,
AMOLWAN DECHAPOL, BA*, CHAIRAT REUNGCHAM, Dip.AN*
Affiliation : * Division of Respiratory Disease and Tuberculosis, Department of Medicine,
** Department of Anaesthesiology,
*** Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700,
Thailand.
t Financially supported by the National Research Council of Thailand.
AbstractThis study aimed to explore the cost-effectiveness of using a questionnaire as a screening
test for Chronic Obstructive Pulmonary Disease (COPD) among the Bangkok elderly residing around
Siriraj Hospital. The gold standard used for diagnosing COPD followed the guidelines of the Thoracic
Society of Thailand. The questionnaire consisted of 10 questions on smoking status, respiratory symp
toms and previous history of pulmonary tuberculosis. There were 3,094 elderly who participated, com
pleted the questionnaire, and underwent spirometry as well as chest radiography in the community. The
results showed that elderly individuals who are smokers (> 0.5 pack-year) or have ever experienced
sudden cough with chest oppression or dyspnea when the weather changes or who have expectorated
more than two tablespoons of sputum would be suspected of having COPD with a sensitiviy of 81.4 per
cent (95% Cl 79.4-83.4), specificity of 62.2 per cent (95% CI 60.4-64.0) false negative rate 1.2 per
cent (95% CI 0.7-1.7) and false positive rate 38 per cent (95% CI 35.3-40.7) and subsequently required
spirometry and chest X-ray for definitive diagnosis. The test needed to screen 17 elderly individuals
to detect one COPD case at a cost of 1,538 baht. This questionnaire is also a self-assessment tool for
COPD screening among the elderly in order to encourage them to seek for early medical attention and
it is recommended that this should be publicized via the mass media.
Keywords : Cost-Effectiveness, Questionnaire, Screening, COPD, Elderly
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