Broadening the Perspective of Cost-Effectiveness Modeling in Chronic Obstructive Pulmonary Disease: A New Patient-Level Simulation Model Suitable to Evaluate Stratified Medicine

Martine Hoogendoorn; Isaac Corro Ramos; Michael Baldwin; Nuria Gonzalez-Rojas Guix; Maureen P M H Rutten-van Mölken

doi:10.1016/j.jval.2018.10.008

Broadening the Perspective of Cost-Effectiveness Modeling in Chronic Obstructive Pulmonary Disease: A New Patient-Level Simulation Model Suitable to Evaluate Stratified Medicine

Value Health. 2019 Mar;22(3):313-321. doi: 10.1016/j.jval.2018.10.008. Epub 2018 Dec 20.

Authors

Martine Hoogendoorn¹, Isaac Corro Ramos², Michael Baldwin³, Nuria Gonzalez-Rojas Guix³, Maureen P M H Rutten-van Mölken²

Affiliations

¹ Institute for Medical Technology Assessment/Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. Electronic address: hoogendoorn@imta.eur.nl.
² Institute for Medical Technology Assessment/Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
³ Boehringer Ingelheim International GmbH, Ingelheim, Germany.

PMID: 30832969
DOI: 10.1016/j.jval.2018.10.008

Abstract

Objectives: To develop a health economic model that included a great diversity of patient characteristics and outcomes for chronic obstructive pulmonary disease (COPD), which can be used to inform decisions about stratified medicine in COPD.

Methods: The choice of patient characteristics and outcomes to include in the model was based on 3 literature reviews on multidimensional prognostic COPD indices, COPD phenotypes, and treatment effects in subgroups. A conceptual model was constructed including 14 patient characteristics, 7 intermediate outcomes (lung function, physical activity, exercise capacity, symptoms, disease-specific quality of life, exacerbations, and pneumonias), and 3 final outcomes (mortality, quality-adjusted life-years [QALYs], and costs). Regression equations describing the statistical associations between the patient characteristics and intermediate and final outcomes were estimated using the longitudinal data of 5 large COPD trials (19,378 patients). A patient-level simulation model was developed in which individual patients from the baseline population of the 5 trials are sampled and their outcomes over lifetime are predicted based on the regression equations.

Results: The base-case analysis (single-arm simulation representing treatment with tiotropium) showed that patients had a mean lung function decline of 43 mL/year, 0.62 exacerbations/year, a worsening of their physical activity and quality of life with 1.48 and 1.10 points/year, a life expectancy of 11.2 years, 7.25 QALYs, and total lifetime costs of £24,891. Results for a selection of treatment scenarios and subgroups were shown to demonstrate the potential of the model.

Conclusions: We developed a unique patient-level simulation model that can be used to evaluate COPD treatment options for a variety of subgroups.

Keywords: chronic obstructive pulmonary disease; costs; discrete event simulation model; personalized medicine; quality-adjusted life-years.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Computer Simulation / economics*
Computer Simulation / trends
Cost-Benefit Analysis / methods*
Cost-Benefit Analysis / trends
Female
Humans
Male
Middle Aged
Models, Economic*
Pulmonary Disease, Chronic Obstructive / diagnosis
Pulmonary Disease, Chronic Obstructive / economics*
Pulmonary Disease, Chronic Obstructive / therapy
Quality-Adjusted Life Years