title: The cost-effectiveness of chest radiography as a screening test for chronic obstructive pulmonary disease among the Bangkok elderly.
abstract: Regular screening with chest radiography (CXR) in an annual physical check up of the elderly is most frequently practiced. This study aimed to identify the CXR indices and the cost-effectiveness of CXR as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities of Bangkok around Siriraj Hospital. The gold standard for diagnosing COPD followed the guidelines of the Thoracic Society of Thailand. There were 3,094 subjects who participated, completed spirometry and a CXR. The selected nine indices from PA and lateral CXR for diagnosing COPD were based on the presence of hyperinflation. The positive criteria of each index were reported. The cut-off point of best average accuracy ie, Z score of the CXR was 0.07 with a sensitivity of 75.9 per cent (95% CI 70.2-81.6%), specificity of 72.4 per cent (95% CI 70.8-74.0%) and the best average accuracy of 74.1 per cent (95% CI 72.5-75.7%) whereas the cost-effective cut-off point of a Z score of CXR as a screening test for COPD was 0.04 at the lowest grand total cost. The cost to detect one case of COPD was 2,008 baht and needed to screen 17 elderly. It is suggested that CXR is probably not a suitable screening test for COPD in the elderly due to the complicated derivation of the CXR indices. However, its efficacy may be of some value in in-office diagnosis of COPD.
authors.affiliation: Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
authors.forename: Benjamas
authors.initials: B
authors.lastname: Chuaychoo
authors.forename: Nanta
authors.initials: N
authors.lastname: Maranetra
authors.forename: Jariya
authors.initials: J
authors.lastname: Lertakyamanee
authors.forename: Chana
authors.initials: C
authors.lastname: Naruman
authors.forename: Wanchai
authors.initials: W
authors.lastname: Dejsomritrutai
authors.forename: Trongtum
authors.initials: T
authors.lastname: Tongdee
authors.forename: Nitipatana
authors.initials: N
authors.lastname: Chierakul
authors.forename: Arth
authors.initials: A
authors.lastname: Nana
authors.forename: Wisanu
authors.initials: W
authors.lastname: Thamlikitkul
authors.forename: Tasneeya
authors.initials: T
authors.lastname: Suthamsmai
authors.forename: Sutee
authors.initials: S
authors.lastname: Saengkaew
authors.forename: Wichean
authors.initials: W
authors.lastname: Sreelum
authors.forename: Montchai
authors.initials: M
authors.lastname: Aksornin
authors.forename: Amolwan
authors.initials: A
authors.lastname: Dechapol
authors.forename: Chairat
authors.initials: C
authors.lastname: Reungcham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D011336:Probability; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000191:economics*; D012372:ROC Curve; D013902:Radiography, Thoracic / Q000191:economics*; D013147:Spirometry / Q000191:economics; D013785:Thailand; D014505:Urban Population