A dynamic population model of disease progression in COPD

Abstract

To contribute to evidence-based policy making, a dynamic Dutch population model of chronic obstructive pulmonary disease (COPD) progression was developed.The model projects incidence, prevalence, mortality, progression and costs of diagnosed COPD by the Global Initiative for Chronic Obstructive Lung Disease-severity stage for 2000-2025, taking into account population dynamics and changes in smoking prevalence over time. It was estimated that of all diagnosed COPD patients in 2000, 27% had mild, 55% moderate, 15% severe and 3% very severe COPD. The severity distribution of COPD incidence was computed to be 40% mild, 55% moderate, 4% severe and 0.1% very severe COPD. Disease progression was modelled as decline in forced expiratory voume in one second (FEV1) % predicted depending on sex, age, smoking and FEV1 % pred. The relative mortality risk of a 10-unit decrease in FEV1 % pred was estimated at 1.2. Projections of current practice were compared with projections assuming that each year 25% of all COPD patients receive either minimal smoking cessation counselling or intensive counselling plus bupropion.In the projections of current practice, prevalence rates between 2000-2025 changed from 5.1 to 11 per 1,000 inhabitants for mild, 11 to 14 per 1,000 for moderate, 3.0 to 3.9 per 1,000 for severe and from 0.5 to 1.3 per 1,000 for very severe COPD. Costs per inhabitant increased from J1.40 to 3.10 for mild, J6.50 to 9.00 for moderate, J6.20 to 8.50 for severe and from J3.40 to 9.40 for very severe COPD (price level 2000). Both smoking cessation scenarios were cost-effective with minimal counselling generating net savings.In conclusion, the chronic obstructive pulmonary disease progression model is a useful instrument to give detailed information about the future burden of chronic obstructive pulmonary disease and to assess the long-term impact of interventions on this burden. KEYWORDS: Chronic obstructive pulmonary disease, cost-effectiveness, disease severity, epidemiology, model, smoking cessation W orldwide, the increase in the prevalence, morbidity, mortality and costs of chronic obstructive pulmonary disease (COPD) that has been projected for future decades [1][2][3] has drawn the attention of healthcare policy makers. They realise that slowing down disease progression is one way to reduce the increasing healthcare costs, as there is a strong association between use of healthcare services and disease severity [4][5][6][7]. Currently the only available intervention proven to slow down disease progression before patients develop severe COPD is smoking cessation. The Lung Health Study (LHS) demonstrated that COPD patients who quit smoking had an improvement in lung function in the first year, and a subsequent rate of decline that was half the rate observed among continued smokers [8].To project the future burden of COPD in The Netherlands by disease severity and to evaluate the impact of different smoking cessation interventions on the national burden of COPD, a population model has been developed that sim...

Development and validation of the Evaluation Platform In COPD (EPIC): a population-based outcomes model of COPD for Canada

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