Development of the Galaxy Chronic Obstructive Pulmonary Disease (COPD) Model Using Data from ECLIPSE: Internal Validation of a Linked-Equations Cohort Model

Briggs, Andrew; Baker, Timothy; Risebrough, Nancy; Chambers, Mike; Gonzalez‐McQuire, Sebastian; Ismaila, Afisi S; Exuzides, Alex; Colby, Chris; Tabberer, Maggie; Muellerova, Hana; Locantore, Nicholas; Mölken, Maureen P. M. H. Rutten van; Lomas, David A.

doi:10.1177/0272989x16653118

Cited by 34 publications

(64 citation statements)

References 23 publications

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“…While older cost-effectiveness models focused on lung-function only, more contemporary models contain comorbidities and symptoms in the characterization of the disease. 53 – 55 However, these models are in need of evidence on the relationship between costs and comorbid conditions or symptoms.…”

Section: Discussionmentioning

confidence: 99%

The contribution of symptoms and comorbidities to the economic impact of COPD: an analysis of the German COSYCONET cohort

Wacker¹,

Kitzing²,

Jörres³

et al. 2017

COPD

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BackgroundAlthough patients with COPD often have various comorbidities and symptoms, limited data are available on the contribution of these aspects to health care costs. This study analyzes the association of frequent comorbidities and common symptoms with the annual direct and indirect costs of patients with COPD.MethodsSelf-reported information on 33 potential comorbidities and symptoms (dyspnea, cough, and sputum) of 2,139 participants from the baseline examination of the German COPD cohort COSYCONET was used. Direct and indirect costs were calculated based on self-reported health care utilization, work absence, and retirement. The association of comorbidities, symptoms, and COPD stage with annual direct/indirect costs was assessed by generalized linear regression models. Additional models analyzed possible interactions between COPD stage, the number of comorbidities, and dyspnea.ResultsUnadjusted mean annual direct costs were €7,263 per patient. Other than COPD stage, a high level of dyspnea showed the strongest driving effect on direct costs (+33%). Among the comorbidities, osteoporosis (+38%), psychiatric disorders (+36%), heart disease (+25%), cancer (+24%), and sleep apnea (+21%) were associated with the largest increase in direct costs (p<0.01). A sub-additive interaction between advanced COPD stage and a high number of comorbidities reduced the independent cost-driving effects of these factors. For indirect costs, besides dyspnea (+34%), only psychiatric disorders (+32%) and age (+62% per 10 years) were identified as significant drivers of costs (p<0.04). In the subsequent interaction analysis, a high number of comorbidities was found to be a more crucial factor for increased indirect costs than single comorbidities.ConclusionDetailed knowledge about comorbidities in COPD is useful not only for clinical purposes but also to identify relevant cost factors and their interactions and to establish a ranking of major cost drivers. This could help in focusing therapeutic efforts on both clinically and economically important comorbidities in COPD.

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Section: Discussionmentioning

confidence: 99%

The contribution of symptoms and comorbidities to the economic impact of COPD: an analysis of the German COSYCONET cohort

Wacker¹,

Kitzing²,

Jörres³

et al. 2017

COPD

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“…EPIC-generated estimate was outside of the 95%CI of UPLIFT. Three other models (19,45,47) generated higher rates than was observed in the trials. EPIC simulated a lower mortality rate over the trial follow-up (12.8%, bottom panel in Figure 5 ) than was observed in TORCH (15.2%); EPIC-generated value was outside of the 95%CI.…”

Section: Resultsmentioning

confidence: 57%

“…al., developed a model of COPD progression based on the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE)(52) data (with resource-use estimates from UPLIFT)(45). The model was based on a rigorous practice of model conceptualization(53), and has performed satisfactorily in internal and external validation studies(18,45). A major advantage of this model is its incorporation of multiple aspects of COPD (such as symptoms and six-minute walking distance, a measure of functional capacity).…”

Section: Discussionmentioning

confidence: 99%

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

Sadatsafavi

Ghanbarian

Adibi

et al. 2018

Preprint

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BackgroundWe report the development, validation, and implementation of an open-source population-based outcomes model of Chronic Obstructive Pulmonary Disease (COPD) for Canada.MethodsEvaluation Platform in COPD (EPIC) is a discrete event simulation model of Canadians 40 years of age or older. Three core features of EPIC are its open-population design (incorporating projections of future population growth, aging, and smoking trends), its incorporation of heterogeneity in lung function decline and burden of exacerbations, and its modeling of the natural history of COPD from inception. Multiple original data analyses, as well as values reported in the literature, were used to populate the model. Extensive face validity as well as internal and external validity evaluations were performed.ResultsThe model was internally validated on demographic projections, mortality rates, lung function trajectories, COPD exacerbations, and stability of COPD prevalence over time within strata of risk factors. In external validation, it moderately overestimated rate of overall exacerbations in two independent trials, but generated consistent estimates of rate of severe exacerbations and mortality.LimitationsIn its current version, EPIC does not consider uncertainty in the evidence. Several components such as additional (e.g., environmental and occupational) risk factors, treatment, symptoms, and comorbidity will have to be added in future iterations.ConclusionsEPIC is the first multi-purpose outcome- and policy-focused model of COPD for Canada. By modeling the natural history of COPD from its inception, it is capable of modeling the outcomes of decisions across the entire care pathway of COPD. Platforms of this type have the capacity to be iteratively updated to incorporate the latest evidence and to project the outcomes of many different scenarios within a consistent framework.

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“…Cost-effectiveness calculations for both analyses 1 and 2 were performed using the GALAXY COPD disease progression model [ 23 ]. The model uses a linked risk equation approach to estimate disease progression, associated healthcare costs (e.g.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of umeclidinium compared with tiotropium and glycopyrronium as monotherapy for chronic obstructive pulmonary disease: a UK perspective

Shah¹,

Driessen

Risebrough³

et al. 2018

Cost Eff Resour Alloc

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BackgroundCost-effectiveness of once-daily umeclidinium bromide (UMEC) was compared with once-daily tiotropium (TIO) and once-daily glycopyrronium (GLY) in patients with chronic obstructive pulmonary disease (COPD) from a UK National Health Service (NHS) perspective.MethodsA linked-equation model was implemented to estimate COPD progression, associated healthcare costs, exacerbations rates, life years (LY) and quality-adjusted LY (QALYs). Statistical risk equations for endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. Treatment effects [mean (standard error)] at 12 weeks on forced expiratory volume in 1 s and St George’s Respiratory Questionnaire score were obtained from the intention-to-treat populations of two head-to-head studies [GSK study identifiers 201316 (NCT02207829) and 201315 (NCT02236611)] which compared UMEC 62.5 mcg with TIO 18 mcg and UMEC 62.5 mcg with GLY 50 mcg, respectively. Treatment costs reflect UK list prices (2016) and NHS unit costs; UMEC and GLY prices being equal and less than TIO. A lifetime horizon, discounted costs and effects at 3.5% were used. Sensitivity analyses were performed to evaluate the robustness of variations in input parameters and assumptions in the model.ResultsOver a lifetime horizon, UMEC was predicted to increase LYs (+ 0.195; 95% confidence interval [CI]: 0.069, 0.356) and QALYs (+ 0.118; 95% CI: 0.055, 0.191) and reduce the number of annual exacerbations (− 0.053; 95% CI: − 0.171, 0.028) compared with TIO, with incremental cost savings of £460/patient (95% CI: − £645, − £240). Compared with GLY, UMEC increased LYs (+ 0.124; 95% CI: 0.015, 0.281) and QALYs (+ 0.101; 95% CI: 0.043, 0.179) and reduced annual exacerbation (− 0.033; 95% CI: − 0.135, 0.017) at an additional cost of £132/patient (95% CI: £12, £330), resulting in an incremental cost-effectiveness ratio of £1310/QALY (95% CI: £284, £2060). Similar results were observed in alternative time horizons and additional sensitivity analyses.ConclusionsFor treatment of patients with COPD in the UK over a lifetime horizon, treatment with UMEC dominates treatment with TIO, providing both improved health outcomes and cost savings. In comparison with GLY, treatment with UMEC achieved improved health outcomes but was associated with a higher cost.Trial registration 201316, NCT02207829; 201315, NCT02236611Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0101-3) contains supplementary material, which is available to authorized users.

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Development of the Galaxy Chronic Obstructive Pulmonary Disease (COPD) Model Using Data from ECLIPSE: Internal Validation of a Linked-Equations Cohort Model

Cited by 34 publications

References 23 publications

The contribution of symptoms and comorbidities to the economic impact of COPD: an analysis of the German COSYCONET cohort

The contribution of symptoms and comorbidities to the economic impact of COPD: an analysis of the German COSYCONET cohort

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

Cost-effectiveness of umeclidinium compared with tiotropium and glycopyrronium as monotherapy for chronic obstructive pulmonary disease: a UK perspective

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