External Validation of Health Economic Decision Models for Chronic Obstructive Pulmonary Disease (COPD): Report of the Third COPD Modeling Meeting

Chronic Obstructive pulmonary disease (COPD) has become the third leading causes of global death. Insufficiency in early-diagnosis and treatment of COPD, especially COPD exacerbation, leads to tremendous economic burden and...

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How to Address Uncertainty in Health Economic Discrete-Event Simulation Models: An Illustration for Chronic Obstructive Pulmonary Disease

Medical Decision Making ◽

10.1177/0272989x20932145 ◽

2020 ◽

Vol 40 (5) ◽

pp. 619-632

Author(s):

Isaac Corro Ramos ◽

Martine Hoogendoorn ◽

Maureen P. M. H. Rutten-van Mölken

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Health Economic ◽

Pulmonary Disease ◽

Discrete Event Simulation ◽

Discrete Event ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Modeling Uncertainty ◽

Event Simulation

Background. Evaluation of personalized treatment options requires health economic models that include multiple patient characteristics. Patient-level discrete-event simulation (DES) models are deemed appropriate because of their ability to simulate a variety of characteristics and treatment pathways. However, DES models are scarce in the literature, and details about their methods are often missing. Methods. We describe 4 challenges associated with modeling heterogeneity and structural, stochastic, and parameter uncertainty that can be encountered during the development of DES models. We explain why these are important and how to correctly implement them. To illustrate the impact of the modeling choices discussed, we use (results of) a model for chronic obstructive pulmonary disease (COPD) as a case study. Results. The results from the case study showed that, under a correct implementation of the uncertainty in the model, a hypothetical intervention can be deemed as cost-effective. The consequences of incorrect modeling uncertainty included an increase in the incremental cost-effectiveness ratio ranging from 50% to almost a factor of 14, an extended life expectancy of approximately 1.4 years, and an enormously increased uncertainty around the model outcomes. Thus, modeling uncertainty incorrectly can have substantial implications for decision making. Conclusions. This article provides guidance on the implementation of uncertainty in DES models and improves the transparency of reporting uncertainty methods. The COPD case study illustrates the issues described in the article and helps understanding them better. The model R code shows how the uncertainty was implemented. For readers not familiar with R, the model’s pseudo-code can be used to understand how the model works. By doing this, we can help other developers, who are likely to face similar challenges to those described here.

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External validation of exhaled breath profiling using an electronic nose in the discrimination of asthma with fixed airways obstruction and chronic obstructive pulmonary disease

Clinical & Experimental Allergy ◽

10.1111/j.1365-2222.2011.03800.x ◽

2011 ◽

Vol 41 (10) ◽

pp. 1371-1378 ◽

Cited By ~ 89

Author(s):

N. Fens ◽

A. C. Roldaan ◽

M. P. van der Schee ◽

R. J. Boksem ◽

A. H. Zwinderman ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Electronic Nose ◽

External Validation ◽

Chronic Obstructive ◽

Exhaled Breath ◽

Obstructive Pulmonary Disease ◽

Airways Obstruction

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Association between Chronic Obstructive Pulmonary Disease and Employment by Industry and Occupation in the US Population: A Study of Data from the Third National Health and Nutrition Examination Survey

American Journal of Epidemiology ◽

10.1093/aje/kwf105 ◽

2002 ◽

Vol 156 (8) ◽

pp. 738-746 ◽

Cited By ~ 162

Author(s):

E. Hnizdo

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

National Health ◽

Chronic Obstructive ◽

Nutrition Examination Survey ◽

Obstructive Pulmonary Disease ◽

The Third ◽

Health And Nutrition ◽

The Us

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Using a Health Economic Framework to Prioritize Quality Indicators: An Example With Smoking Cessation in Chronic Obstructive Pulmonary Disease

MDM Policy & Practice ◽

10.1177/2381468319852358 ◽

2019 ◽

Vol 4 (1) ◽

pp. 238146831985235

Author(s):

Austin Nam ◽

David M. J. Naimark ◽

Matthew B. Stanbrook ◽

Murray D. Krahn

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Health Care ◽

Health Economic ◽

Smoking Cessation ◽

Pulmonary Disease ◽

Quality Indicators ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Economic Framework ◽

Life Years

Background. Health care performance monitoring is a major focus of the modern quality movement, resulting in widespread development of quality indicators and making prioritizations an increasing focus. Currently, few prioritization methods of performance measurements give serious consideration to the association of performance with expected health benefits and costs. We demonstrate a proof-of-concept application of using a health economic framework to prioritize quality indicators by expected variations in population health and costs, using smoking cessation in chronic obstructive pulmonary disease (COPD) as an example. Methods. We developed a health state transition, microsimulation model to represent smoking cessation practices for adults with COPD from the health care payer perspective in Ontario, Canada. Variations in life years, quality-adjusted life years (QALYs), and lifetime costs were associated with changes in performance. Incremental net health benefit (INHB) was used to represent the joint variation in mortality, morbidity, and costs associated with the performance of each quality indicator. Results. Using a value threshold of $50,000/QALY, the indicators monitoring assessment of smoking status and smoking cessation interventions were associated with the largest INHBs. Combined performance variations among groups of indicators showed that 81% of the maximum potential INHB could be represented by three out of the six process indicators. Conclusions. A health economic framework can be used to bring dimensions of population health and costs into explicit consideration when prioritizing quality indicators. However, this should not preclude policymakers from considering other dimensions of quality that are not part of this framework.

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Conceptualization, Development, And Internal And External Validation of A ‘Whole Disease’ Model for Chronic Obstructive Pulmonary Disease

Value in Health ◽

10.1016/j.jval.2017.08.2015 ◽

2017 ◽

Vol 20 (9) ◽

pp. A735

Author(s):

S Ghanbarian ◽

D Sin ◽

A Adibi ◽

JM FitzGerald ◽

S Bryan ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

External Validation ◽

Disease Model ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

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A Refined View of Airway Microbiome in Chronic Obstructive Pulmonary Disease at Species and Strain-levels

10.1101/2020.01.18.908624 ◽

2020 ◽

Cited By ~ 2

Author(s):

Zhang Wang ◽

Haiyue Liu ◽

Fengyan Wang ◽

Yuqiong Yang ◽

Xiaojuan Wang ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Species Level ◽

Chronic Obstructive ◽

Third Generation ◽

Eosinophilic Inflammation ◽

Obstructive Pulmonary Disease ◽

The Third ◽

Airway Microbiome ◽

Inflammatory Phenotype

AbstractLittle is known about the species and strain-level diversity of the airway microbiome, and its implication in chronic obstructive pulmonary disease (COPD).Here we report the first comprehensive analysis of the COPD airway microbiome at species and strain-levels. The full-length 16S rRNA gene was sequenced from sputum in 98 stable COPD patients and 27 age-matched healthy controls, using the ‘third-generation’ Pacific Biosciences sequencing platform.Individual species within the same genus exhibited reciprocal relationships with COPD and disease severity. Species dominant in health can be taken over by another species within the same genus in GOLD IV patients. Such turnover was also related to enhanced symptoms and exacerbation frequency. Ralstonia mannitolilytica, an opportunistic pathogen, was significantly increased in COPD frequent exacerbators. There were inflammatory phenotype-specific associations of microbiome at the species-level. One group of four pathogens including Haemophilus influenzae and Moraxella catarrhalis, were specifically associated with sputum mediators for neutrophilic inflammation. Another group of seven species, including Tropheryma whipplei, showed specific associations with mediators for eosinophilic inflammation. Strain-level detection uncovered three non-typeable H. influenzae strains PittEE, PittGG and 86-028NP in the airway microbiome, where PittGG and 86-028NP abundances may inversely predict eosinophilic inflammation. The full-length 16S data augmented the power of functional inference and led to the unique identification of butyrate-producing and nitrate reduction pathways as significantly depleted in COPD.Our analysis uncovered substantial intra-genus heterogeneity in the airway microbiome associated with inflammatory phenotypes and could be of clinical importance, thus enabled a refined view of the airway microbiome in COPD.“Take-home” messageThe species-level analysis using the ‘third-generation’ sequencing enabled a refined view of the airway microbiome and its relationship with clinical outcome and inflammatory phenotype in COPD.

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Emerging Therapeutic Options for the Management of COPD

Clinical Medicine Insights Circulatory Respiratory and Pulmonary Medicine ◽

10.4137/ccrpm.s8140 ◽

2013 ◽

Vol 7 ◽

pp. CCRPM.S8140 ◽

Cited By ~ 3

Author(s):

Debra J. Reid ◽

Nga T. Pham

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Airway Inflammation ◽

Pulmonary Disease ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Current Management ◽

Efficacy Data ◽

Obstructive Pulmonary Disease ◽

Safety And Efficacy ◽

The Third

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide and is projected to be the third by 2020. COPD is characterized by chronic airflow limitation caused by airway inflammation and parenchymal destruction that is usually progressive. Inhaled bronchodilators continue to be the mainstay of the current management of COPD. Safety and efficacy data of the recently approved medications including aclidinium, glycopyrronium, roflumilast, and indacaterol are reviewed here.

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