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

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.

• The 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.

• The 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.

• Policymakers should consider implementing coverage and reimbursement policies that incentivize the adoption of the SwaRSA strategy, particularly the use of the EAT-10 self-assessment tool and subsequent swallowing rehabilitation, as a means to improve COPD outcomes while generating cost savings for the healthcare system.

• 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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