Cost effectiveness of a novel SwaRSA Strategy to reduce acute exacerbations of COPD

Swallowing difficulties among people with COPD affect up to 56% of hospitalized patients. On current evidence, integrating swallowing assessment and rehabilitation into COPD management should be a priority for healthcare policy.
Cost effectiveness of a novel SwaRSA Strategy to reduce acute exacerbations of COPD
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BioMed Central
BioMed Central BioMed Central

Cost effectiveness of a novel swallowing and respiratory sensation assessment and a modelled intervention to reduce acute exacerbations of COPD - BMC Pulmonary Medicine

Swallowing impairment observed in ~ 20% of people with Chronic Obstructive Pulmonary Disease (COPD) may increase the risk of aspiration pneumonia and acute exacerbations. We designed a decision analytic model to assess the cost-effectiveness of the Swallowing and Respiratory Sensation Assessment (SwaRSA) tests and swallowing rehabilitation to reduce COPD exacerbations. We believe that swallowing rehabilitation to improve coordination of swallowing and breathing may reduce exacerbations in people with COPD.From the Australia health system perspective, we assessed the cost effectiveness of four tests relative to standard of care, or no testing, over a time horizon of one year. The SwaRSA tests assessed relative to a standard of care arm of no testing: included the Eating Assessment Tool (EAT-10) score, Swallowing Capacity of Liquids, Tongue Strength Assessment, and Respiratory Sensation Assessment, in people with moderate to severe COPD. Outcome measures were COPD exacerbations per year, which were converted into quality adjusted life years (QALYs). Model inputs including costs, test sensitivities and specificities, COPD exacerbation risks, and exacerbation-related utilities were derived from published sources. Our assumptions on the costs, recovery, and risk reduction are based on the available data on pulmonary rehabilitation in COPD.Relative to no-SwaRSA, three individual testing strategies were found to be cost-effective at incremental cost effectiveness ratio per QALY ranging from $27,000 to $37,000 AUD assuming a willingness to pay of $50,000 AUD. The EAT-10 and the tongue strength were the two dominant options on the cost-effectiveness frontier. Model results were robust to variations in one-way and probabilistic sensitivity analyses.In COPD, SwaRSA modelling suggests that self-assessment with the EAT-10 and subsequent intervention is highly cost-effective relative to no-SwaRSA.

The paper discusses the significant economic burden of Chronic Obstructive Pulmonary Disease (COPD) and the potential cost savings from reducing COPD exacerbations. A decision analytic model that evaluates the cost-effectiveness of a Swallowing and Respiratory Sensation Assessment (SwaRSA) strategy, involving swallowing and respiratory sensation assessment tests and subsequent swallowing rehabilitation, is presented to reduce COPD exacerbations. The model suggests that self-assessment with the Eating Assessment Tool (EAT-10) and subsequent intervention is a highly cost-effective option compared to no-SwaRSA.

Key Points: Novel SwaRSA Decision Analytic Model; Epiu I. et al 2025 https://pubmed.ncbi.nlm.nih.gov/40200355/

Economic Burden of COPD

  • COPD represents a considerable economic burden globally, with an estimated cost of US$ 2.1 trillion.
  • Annual COPD costs in the USA are expected to increase to 40 billion USD per year.
  • Australia spent about AUD$ 831.6 million in 2020-21 on the management of COPD, with over half of this cost for hospital care.

Potential for Cost Savings

  • A significant portion of the COPD management cost could be avoided by reducing exacerbations.

Cost-Effectiveness of SwaRSA Strategy

  • The decision analytic model assessed the cost-effectiveness of a Swallowing and Respiratory Sensation Assessment (SwaRSA) strategy, which involved swallowing and respiratory sensation assessment tests and subsequent swallowing rehabilitation.
  • Three individual testing strategies within the SwaRSA approach were found to be cost-effective, with incremental cost-effectiveness ratios per QALY ranging from $27,000 to $37,000 AUD.
  • The EAT-10 and the tongue strength were the two dominant options on the cost-effectiveness frontier.
  • The model results were robust to variations in one-way and probabilistic sensitivity analyses, and the self-assessment with the EAT-10 and subsequent intervention was highly cost-effective relative to no-SwaRSA.

Here are the key implications of the findings for healthcare policy regarding COPD management:

  • The high economic burden of COPD, estimated at over $2 trillion globally and $40 billion annually in the US, highlights the need for more effective and cost-efficient management strategies.

  • Novel finding that a significant portion of COPD costs could be avoided by reducing exacerbations suggests that interventions targeting exacerbation prevention should be a priority for policymakers.

  • The high prevalence of swallowing difficulties (dysphagia) among COPD patients, affecting up to 56% of hospitalized patients, suggests that screening and management of swallowing disorders should be integrated into standard COPD care.

  • This cost-effectiveness analysis of the SwaRSA strategy, which includes swallowing and respiratory sensation assessment tests followed by swallowing rehabilitation, provides strong evidence that such an approach can be a highly cost-effective way to reduce COPD exacerbations and associated costs.

  • Further research may be needed to validate these findings in different healthcare settings and populations, but the current evidence suggests that integrating swallowing assessment and rehabilitation into COPD management should be a priority for healthcare policy

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Respiratory Physiology
Life Sciences > Biological Sciences > Physiology > Respiratory Physiology
Respiratory Management
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