Cost-effectiveness of targeted COPD case-finding with the PUMA questionnaire followed by spirometry among ever-smokers in Singapore
9 affiliations
- 1Division of Economics, Nanyang Technological University, Singapore, Singapore
- 2Primary Care and Family Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- 3MOH Office for Healthcare Transformation, Singapore, Singapore
- 4Kenneth Tan Medical Clinic, Singapore, Singapore
- 5Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- 6NHG Polyclinics, NHG Health, Singapore, Singapore
- 7Department of General Practice and Primary Care, University of Melbourne, Melbourne, VIC Australia
- 8Research Institute for Cancer Prevention, Screening and Early Detection, Singapore, Singapore
- 9Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
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.
Methods: 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.
Results: 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.
Conclusions: PUMA-based targeted COPD case-finding followed by spirometry is likely to be cost-effective at Singapore’s willingness-to-pay threshold.
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BibTeX
@article{ooi2026costeffectiveness,
title = {{Cost-effectiveness of targeted COPD case-finding with the PUMA questionnaire followed by spirometry among ever-smokers in Singapore}},
author = {Irene Li Peng Ooi and Vicky Mengqi Qin and Eng Sing Lee and Kenneth Tan and Geak Poh Tan and Jo-Anne Manski-Nankervis and Akshar Saxena},
journal = {NPJ Primary Care Respiratory Medicine},
year = {2026},
month = jul,
doi = {10.1038/s41533-026-00533-2},
url = {https://doi.org/10.1038/s41533-026-00533-2},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Cost-effectiveness of targeted COPD case-finding with the PUMA questionnaire followed by spirometry among ever-smokers in Singapore
AU - Irene Li Peng Ooi
AU - Vicky Mengqi Qin
AU - Eng Sing Lee
AU - Kenneth Tan
AU - Geak Poh Tan
AU - Jo-Anne Manski-Nankervis
AU - Akshar Saxena
PY - 2026
DA - 2026/07/08
JO - NPJ Primary Care Respiratory Medicine
DO - 10.1038/s41533-026-00533-2
UR - https://doi.org/10.1038/s41533-026-00533-2
AB - 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. Methods: 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. Results: 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. Conclusions: PUMA-based targeted COPD case-finding followed by spirometry is likely to be cost-effective at Singapore’s willingness-to-pay threshold.
SN - 2055-1010
ER -