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Cost-effectiveness models for chronic obstructive pulmonary disease: Cross-model comparison of hypothetical treatment scenarios.
Value Health 17, 525-536 (2014)
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.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
COPD ; Cost-effectiveness ; Model ; Validation; Dynamic Population-model; Systematic Analysis; Global Burden; Lung-disease; Markov Model; Severe Copd; Exacerbations; Complications; Mortality; Classification
ISSN (print) / ISBN
1098-3015
e-ISSN
1524-4733
Journal
Value in Health
Quellenangaben
Volume: 17,
Issue: 5,
Pages: 525-536
Publisher
Elsevier
Publishing Place
New York, NY
Reviewing status
Peer reviewed
Institute(s)
Institute of Health Economics and Health Care Management (IGM)
German Center for Lung Research (DZL)
German Center for Lung Research (DZL)