Economic evaluations of screening and case-finding for Chronic Obstructive Pulmonary Disease (COPD): a systematic review

Abstract Chronic obstructive pulmonary disease (COPD) imposes significant health and economic burdens globally. Screening and case-finding strategies are increasingly recognized as critical methods to enhance early diagnosis and management of COPD. It is important to understand the economic impact and cost-effectiveness of these strategies to inform the population health policies and real-world practice. In this study, we aim to summarize and compare the economic evaluations of COPD screening and case-finding strategies. We searched PubMed, EMBASE, Cochrane Library, and NHS economic databases for all published studies up to April 2025 that reported economic outcomes, including cost-effectiveness, budget impact, or cost analysis, related to screening and case-finding of COPD. Data extraction included study type, target population, methods, cost perspectives, and outcome measures. Findings were synthesized narratively. This systematic review was registered in PROSPERO (CRD42024516534). We identified 18 eligible studies that met the inclusion criteria, including 11 empirical and 7 modeling studies. A range of screening and case-finding approaches were evaluated, with most studies (n = 16) employing questionnaires either as standalone tools (n = 14) or for pre-screening purposes before the portable spirometer test (n = 8). Portable spirometers were also commonly used (n = 10). The economic outcome measures varied across studies, including cost per additional case detected, cost per quality-adjusted-life-year (QALY) gained, and program-level budget impact. Healthcare sector and payer’s perspectives were the most commonly adopted. While studies consistently suggested that targeted screening strategies were likely to be cost-effective, considerable heterogeneity in study designs, target populations, and economic measures limited direct comparisons between the strategies. COPD screening and case-finding showed potential of being cost-effective preventive strategies, particularly for high-risk groups. However, the lack of standardized descriptions for the details of the implemented strategies and the diverse outcome measures reported across existing studies limits the comparability between these strategies. Future research is needed to assess the long-term economic impact on healthcare systems and to explore personalized compared with one-size-fits-all screening strategies for COPD.