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Original ArticleOpen Access
The Cost-Effectiveness of Chest Radiography as a Screening Test for Chronic Obstructive Pulmonary Disease among the Bangkok Elderly
Chuaychoo B 
,
Maranetra N ,
Lertakyamanee J ,
Nuruman C ,
Dejsomritrutai W ,
Tongdee T ,
Chierakul N ,
Nana A ,
Thamlikitkul W ,
Suthamsmai T ,
Saengkaew S ,
Sreelum W ,
Aksornin DM ,
Dechapol A ,
Reungcham BC
,
Maranetra N ,
Lertakyamanee J ,
Nuruman C ,
Dejsomritrutai W ,
Tongdee T ,
Chierakul N ,
Nana A ,
Thamlikitkul W ,
Suthamsmai T ,
Saengkaew S ,
Sreelum W ,
Aksornin DM ,
Dechapol A ,
Reungcham BC 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 hyperinfla-
tion. 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
Vol. 86 No. 11
COST-EFFECTIVENESS OF CXR SCREENING FOR COPD
1043
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.
Key word : COPD, Elderly, Cost-Effectiveness, Chest Radiography, Screening
CHUA YCHOO B,
MARANETRA N, LERTAKYAMANEE
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 hyperinfla-
tion. 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
Vol. 86 No. 11
COST-EFFECTIVENESS OF CXR SCREENING FOR COPD
1043
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.
Key word : COPD, Elderly, Cost-Effectiveness, Chest Radiography, Screening
CHUA YCHOO B,
MARANETRA N, LERTAKYAMANEE
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