Economic Modeling in Chronic Obstructive Pulmonary Disease

Abstract

Calculating the cost-effectiveness of interventions is an important step in accurately assessing the health and financial burdens of a disease. Although clinical trials that include cost data can be used to compare the cost-effectiveness of specific interventions, they only deal with outcomes within the time frame of the trial. Health economic models can synthesize epidemiologic, clinical, economic, and quality-of-life data from many different sources and extrapolate results to a point many years in the future. The models generally compare interventions with respect to the costs per life-year gained or per quality-adjusted life-year gained. The use of health economic models to assess the economic burden of chronic obstructive pulmonary disease (COPD) and the value of interventions is growing, and will continue to do so as the burden of the disease is better appreciated. Several COPD disease-state models have been described; each uses a consistent definition of COPD severity that is based on FEV(1)% predicted, but the models differ in the allowed transitions, disease progression estimates, utility weights, and costs. This article reviews COPD health economic models and discusses the importance of survival benefits and utilities (health state valuations) for COPD in economic models.

Cost Effectiveness of Pharmacological Maintenance Treatment for Chronic Obstructive Pulmonary Disease

“…These were all very recent papers not yet indexed [21] In addition to these studies, six papers discussing methodological aspects of pharmacoeconomic evaluations in COPD were taken into account. [22][23][24][25][26][27] …”

“…These have been reviewed previously. [23] An important variation is the inconsistency in the extent and length of utility reduction due to an exacerbation. In the studies in this review, the utility decrement was modelled either as a constant value or as a percentage of reduction from the stable state.…”

Developing and Applying a Stochastic Dynamic Population Model for Chronic Obstructive Pulmonary Disease

“…Structural differences between the models exist regarding the number of COPD severity stages, duration of the Markov cycles, inclusion of the risk factors age and smoking, distinction in severity of exacerbations, and inclusion of COPD incidence. Furthermore, the models substantially differ in utility values assigned to COPD stages and utility decrements assigned to exacerbations [15]. Finally, not all the models take into account the uncertainty around the input parameters, which is currently regarded as essential in cost-effectiveness analyses [16,17].…”

Development of the EXACT-U: A Preference-Based Measure to Report COPD Exacerbation Utilities

“…While this may be acceptable for evaluations of interventions to treat stable COPD, interventions that change the frequency, severity, or duration of exacerbations need more accurate measurement in order to capture treatment benefits. It is time consuming and costly to administer the EQ-5D daily in anticipation of capturing the few that start to experience an exacerbation, and is thus done rarely [54]. Moreover, when the EQ-5D has been measured during an exacerbation, sensitivity to daily change has been notably low, with the effect of treatment only seen after several weeks, particularly in the moderate exacerbation group [7,55].…”