{
  "abstract": "Background: Chronic obstructive pulmonary disease (COPD) is frequently undiagnosed among ever-smokers. We evaluated the cost-effectiveness of targeted COPD case-finding using the PUMA questionnaire followed by spirometry among ever-smokers aged 50 years and older in Singapore.\n\nMethods: A cohort Markov model compared two strategies: PUMA-based case-finding (PUMA score ≥4) followed by spirometry versus no case-finding, over a lifetime horizon from the healthcare payer perspective, with 3% annual discounting. A willingness-to-pay threshold of SGD75,000/QALY was applied.\n\nResults: Case-finding yielded an incremental cost of SGD 2,475 and an incremental gain of 0.0339 QALYs per person (ICER: SGD 73,065/QALY). Probabilistic sensitivity analysis indicated a 71.1% probability of being cost-effective at SGD 75,000/QALY. The ICER was most sensitive to the odds ratio of exacerbation for individuals with mild and moderate COPD treated with Long-Acting Muscarinic Antagonist (LAMA), and the severity distribution of undiagnosed COPD.\n\nConclusions: PUMA-based targeted COPD case-finding followed by spirometry is likely to be cost-effective at Singapore’s willingness-to-pay threshold.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Economics, Nanyang Technological University, Singapore, Singapore",
    "Primary Care and Family Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore",
    "MOH Office for Healthcare Transformation, Singapore, Singapore",
    "Kenneth Tan Medical Clinic, Singapore, Singapore",
    "Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore",
    "NHG Polyclinics, NHG Health, Singapore, Singapore",
    "Department of General Practice and Primary Care, University of Melbourne, Melbourne, VIC Australia",
    "Research Institute for Cancer Prevention, Screening and Early Detection, Singapore, Singapore",
    "Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Irene Li Peng Ooi"
    },
    {
      "affs": [
        1
      ],
      "name": "Vicky Mengqi Qin"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Eng Sing Lee"
    },
    {
      "affs": [
        3
      ],
      "name": "Kenneth Tan"
    },
    {
      "affs": [
        4
      ],
      "name": "Geak Poh Tan"
    },
    {
      "affs": [
        1,
        5,
        6,
        7,
        8
      ],
      "name": "Jo-Anne Manski-Nankervis"
    },
    {
      "affs": [
        0
      ],
      "name": "Akshar Saxena"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/11xr5hm8gqm49.bib",
  "cited_by": 0,
  "doi": "10.1038/s41533-026-00533-2",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13724713/",
  "id": "11xr5hm8gqm49",
  "issns": [
    "2055-1010"
  ],
  "landing_url": "https://doi.org/10.1038/s41533-026-00533-2",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Article"
    ],
    [
      "openalex",
      "2740|Chronic Obstructive Pulmonary Disease (COPD) Research"
    ]
  ],
  "openalex": "W7167601241",
  "pdf_url": "https://www.nature.com/articles/s41533-026-00533-2_reference.pdf",
  "pmcid": "PMC13724713",
  "pmid": "42420300",
  "published": "2026-07-08",
  "publisher": "Nature Publishing Group",
  "ris": "https://research.draconitic.com/paper/11xr5hm8gqm49.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T12:23:14Z",
      "native_id": "PMC13724713",
      "source": "pmc",
      "url": "https://doi.org/10.1038/s41533-026-00533-2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Chronic Obstructive Pulmonary Disease (COPD) Research",
      "subfield": "general"
    }
  ],
  "title": "Cost-effectiveness of targeted COPD case-finding with the PUMA questionnaire followed by spirometry among ever-smokers in Singapore",
  "title_text": "Cost-effectiveness of targeted COPD case-finding with the PUMA questionnaire followed by spirometry among ever-smokers in Singapore",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:21:07Z",
  "url": "https://research.draconitic.com/paper/11xr5hm8gqm49",
  "venue": "NPJ Primary Care Respiratory Medicine",
  "versions": []
}