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

Background. A large, population-based intervention (the DIMCA study) has sh own substantial underdiagnosis of chronic obstructive pulmonary disease and asthma, Detection of undiagnosed patients by means of screening and subseq uent monitoring was relatively inexpensive per detected patient, compared w ith other mass screening programs. The objectives of this study were to ass ess whether early detection according to the DIMCA protocol leads to increa sed utilization of health care resources and cost, other than the cost of t he scheduled visits. Methods. In a prospective randomized consent trial, the utilization of heal th 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 su bjects, consultation frequency before screening was compared with the frequ ency after screening. Subjects were a random sample from the general popula tion of between 25 and 70 years of age. Results. During an average follow-up of 3.6 years, there were no significan t differences in health care resource utilization and cost between the scre ened subjects and the controls. Resource utilization before screening was n ot significantly different from resource utilization after screening. Stati stically significant differences were found within the screened group: subj ects with a positive screening result (i.e., with signs or symptoms of obst ructive airway disease) consulted their general practitioners 3.7 times mor e frequently (P = 0.001) for respiratory reasons than subjects with a negat ive 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. (C) 2000 Americ an Health Foundation and Academic Press.