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Cost-Effectiveness Models for Chronic Obstructive Pulmonary Disease: Cross-Model Comparison of Hypothetical Treatment Scenarios

Hoogendoorn, Martine; Feenstra, Talitha L; Asukai, Yumi; Borg, Sixten LU ; Hansen, Ryan N; Jansson, Sven-Arne; Samyshkin, Yevgeniy; Wacker, Margarethe; Briggs, Andrew H and Lloyd, Adam, et al. (2014) In Value in Health 17(5). p.525-536
Abstract
Objectives



To compare different chronic obstructive pulmonary disease (COPD) cost-effectiveness models with respect to structure and input parameters and to cross-validate the models by running the same hypothetical treatment scenarios.



Methods



COPD modeling groups simulated four hypothetical interventions with their model and compared the results with a reference scenario of no intervention. The four interventions modeled assumed 1) 20% reduction in decline in lung function, 2) 25% reduction in exacerbation frequency, 3) 10% reduction in all-cause mortality, and 4) all these effects combined. The interventions were simulated for a 5-year and lifetime horizon with standardization, if... (More)
Objectives



To compare different chronic obstructive pulmonary disease (COPD) cost-effectiveness models with respect to structure and input parameters and to cross-validate the models by running the same hypothetical treatment scenarios.



Methods



COPD modeling groups simulated four hypothetical interventions with their model and compared the results with a reference scenario of no intervention. The four interventions modeled assumed 1) 20% reduction in decline in lung function, 2) 25% reduction in exacerbation frequency, 3) 10% reduction in all-cause mortality, and 4) all these effects combined. The interventions were simulated for a 5-year and lifetime horizon with standardization, if possible, for sex, age, COPD severity, smoking status, exacerbation frequencies, mortality due to other causes, utilities, costs, and discount rates. Furthermore, uncertainty around the outcomes of intervention four was compared.



Results



Seven out of nine contacted COPD modeling groups agreed to participate. The 5-year incremental cost-effectiveness ratios (ICERs) for the most comprehensive intervention, intervention four, was €17,000/quality-adjusted life-year (QALY) for two models, €25,000 to €28,000/QALY for three models, and €47,000/QALY for the remaining two models. Differences in the ICERs could mainly be explained by differences in input values for disease progression, exacerbation-related mortality, and all-cause mortality, with high input values resulting in low ICERs and vice versa. Lifetime results were mainly affected by the input values for mortality. The probability of intervention four to be cost-effective at a willingness-to-pay value of €50,000/QALY was 90% to 100% for five models and about 70% and 50% for the other two models, respectively.



Conclusions



Mortality was the most important factor determining the differences in cost-effectiveness outcomes between models. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
COPD, cost-effectiveness, model, validation
in
Value in Health
volume
17
issue
5
pages
525 - 536
publisher
Wiley-Blackwell
external identifiers
  • pmid:25128045
  • wos:000341084700006
  • scopus:84906243763
ISSN
1098-3015
DOI
10.1016/j.jval.2014.03.1721
language
English
LU publication?
yes
id
4cf2662d-c2e8-4e7d-b83e-1b1a82019b73 (old id 4614518)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/25128045?dopt=Abstract
date added to LUP
2014-09-07 16:07:08
date last changed
2017-11-19 03:05:31
@article{4cf2662d-c2e8-4e7d-b83e-1b1a82019b73,
  abstract     = {Objectives<br/><br>
<br/><br>
To compare different chronic obstructive pulmonary disease (COPD) cost-effectiveness models with respect to structure and input parameters and to cross-validate the models by running the same hypothetical treatment scenarios.<br/><br>
<br/><br>
Methods<br/><br>
<br/><br>
COPD modeling groups simulated four hypothetical interventions with their model and compared the results with a reference scenario of no intervention. The four interventions modeled assumed 1) 20% reduction in decline in lung function, 2) 25% reduction in exacerbation frequency, 3) 10% reduction in all-cause mortality, and 4) all these effects combined. The interventions were simulated for a 5-year and lifetime horizon with standardization, if possible, for sex, age, COPD severity, smoking status, exacerbation frequencies, mortality due to other causes, utilities, costs, and discount rates. Furthermore, uncertainty around the outcomes of intervention four was compared.<br/><br>
<br/><br>
Results<br/><br>
<br/><br>
Seven out of nine contacted COPD modeling groups agreed to participate. The 5-year incremental cost-effectiveness ratios (ICERs) for the most comprehensive intervention, intervention four, was €17,000/quality-adjusted life-year (QALY) for two models, €25,000 to €28,000/QALY for three models, and €47,000/QALY for the remaining two models. Differences in the ICERs could mainly be explained by differences in input values for disease progression, exacerbation-related mortality, and all-cause mortality, with high input values resulting in low ICERs and vice versa. Lifetime results were mainly affected by the input values for mortality. The probability of intervention four to be cost-effective at a willingness-to-pay value of €50,000/QALY was 90% to 100% for five models and about 70% and 50% for the other two models, respectively.<br/><br>
<br/><br>
Conclusions<br/><br>
<br/><br>
Mortality was the most important factor determining the differences in cost-effectiveness outcomes between models.},
  author       = {Hoogendoorn, Martine and Feenstra, Talitha L and Asukai, Yumi and Borg, Sixten and Hansen, Ryan N and Jansson, Sven-Arne and Samyshkin, Yevgeniy and Wacker, Margarethe and Briggs, Andrew H and Lloyd, Adam and Sullivan, Sean D and Rutten-van Mölken, Maureen P M H},
  issn         = {1098-3015},
  keyword      = {COPD,cost-effectiveness,model,validation},
  language     = {eng},
  number       = {5},
  pages        = {525--536},
  publisher    = {Wiley-Blackwell},
  series       = {Value in Health},
  title        = {Cost-Effectiveness Models for Chronic Obstructive Pulmonary Disease: Cross-Model Comparison of Hypothetical Treatment Scenarios},
  url          = {http://dx.doi.org/10.1016/j.jval.2014.03.1721},
  volume       = {17},
  year         = {2014},
}