The Most Cost-Effective Screening Method for Chronic
Obstructive Pulmonary Disease among the Bangkok
Elderlyt
BENJAMAS CHUAYCHOO, MD*, NANTA MARANETRA, MD, FRACP, FRCP*,
CHANA NARUMAN,MSc*, WANCHAI DEJSOMRITRUTAI, MD*,
JARIYA LERTAKYAMANEE, MD**, NITIPATANA CHIERKUL, MD*,
ARTH NANA, MD*, WISANU THAMLIKITKUL, MD***,
TASNEEYA SUTHAMSMAI, MSc*, SUTEE SAENGKAEW, BN*,
WICHEAN SREELUM, Dip.MST* MONTCHAI AKSORNIN, Dip.AN*,
AMOLWAN DECHAPOL,BA* WICHEAN SATHET , 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.
AbstractOur previous studies demonstrated the high prevalence and incidence of Chronic Obstructive
Pulmonary Disease (COPD) among the Bangkok elderly, as well as the cost-effectiveness of a question
naire, chest radiography, and mini peak expiratory flow rate (miniPEF) as screening tools. This final
study aimed to identify the most cost-effective screening method among individual, serial and parallel
combinations of the above tools, based on the guidelines for diagnosing COPD of the Thoracic Society
of Thailand. There were 3,094 elderly aged 60 years and over in 124 urban communities around Siriraj
Hospital who participated and completed all the tests.
The results showed that the most cost-effective screening method was the miniPEF at cut-off
percentage of 62 per cent of predicted value. This needed to screen 19 elderly people at a cost of 923
baht to detect one case of COPD, with a false negative rate of 1.9 per cent (95%CI 1.3-2.5), a false
positive rate of 17.5 per cent (95%CI 15.4-19.6). The questionnaire is the alternative choice of screening
tool.
Keywords : COPD, Elderly, Cost-effective, Screening
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