Chronic obstructive pulmonary disorder

Between 2007 and 2032, health care expenditures will triple for COPD.

Prevalence estimates of COPD are as high as 11.4% to 26.1% for the population older than 40 years. The Global burden of disease study 2010 showed that COPD is the 3rd leading cause of death and the 9th cause of DALYs worldwide. There are many pharmacological and non-pharmacological treatment options. iMTA has done trial-based, model-based as well as real-world economic evaluations of: medication (e.g. POET trial, BRONCUS trial), pulmonary rehabilitation (e.g. INTERCOM trial), nutritional counselling and supplements (NUTRAIN trial), integrated care (e.g. RECODE trial), smoking cessation, early assisted discharge (GO-AHEAD trial), etc

iMTA has also done many methodological studies on COPD cost effectiviness like a DCE on home versus hospital care, a DCE on components of the burden of disease, utility measurement of COPD health profiles, algorithms to adjust for COPD severity in real-world studies, estimation of the case-fatality of COPD-exacerbations, investigating the ability of the new GOLD classification to predict mortality, exacerbation and lung funtion declince, etc.

Key achievements in the field of COPD

Costing study

iMTA has performed studies on the current and future cost-of illness of asthma, COPD and allergic rhinitis. In all three diseases, medication is the most important cost driver, followed by hospital admissions in asthma and COPD and by primary care in allergic rhinitis. Between 2007 and 2032, health care expenditures will increase with 73% for allergic rhinitis. They will double for asthma and triple for COPD.

Economic evaluations

iMTA has performed several important cost-effectiveness studies in COPD among which:

GO-AHEAD trial: From a health care perspective, early assisted discharge was cost saving when compared to hospital treatment: -244 Euro in the treatment phase and -168 Euro in the 3 months of follow-up.
INTERCOM trial: This community-based pulmonary rehab program showed improvements in excercise capacity, dyspnea, and health status. Costs per QALY were 32,000 Euro but reduced to 8,000 Euro when 5 patients who were admitted for inpatient rehab were excluded.
POET trial: Tiotropium reduced exacerbations and exacerbation-related costs, but increased total costs when compared with salmeterol. Tiotropium can be considered cost-effective as the resulting cost-effectiveness ratios were below commonly accepted willingness-to-pay thresholds.

iMTA has also performed several model-based cost-effectiveness studies of smoking cessation interventions, as well as economic evaluation of 22 disease management programs. Key success factors of the disease management program were lifestyle related. A comprehensive disease management program is effective and can be cost-effective.

Late phase studies & real world evidence

iMTA has developed 2 COPD models. One is a dynamic, population-based model that was developed in collaboration with RIVM. This model is very extensive and starts from the incidence of COPD in the general population. It can be used to model the cost-effectiveness of many different COPD interventions, including smoking cessation support. It can also be used to project the future cost-of-illness. The second is a model of bronchodilator therapy in COPD. iMTA has further done a country-adaptation of a Markov model for roflumilast. iMTA is chairing an international network of COPD modellers working on cross model validation and external validation of existing models.

Value of information analysis

Using the bronchodilator COPD model, a VoI was conducted to prioritize future research on the cost-effectiveness of bronchodilator treatment. Research on utilities and transition probabilities between COPD-severity stages was found to be most important.

Preference measurement / DCE & TTO

iMTA is investigating the potential of a respiratory bolt-on for the EQ-5D. It has also done direct utility measurement of COPD health profiles using TTO in the general population. We also developed an algorithm to map CCQ to EQ-5D. Furthermore, iMTA has done comparisons of the validity, reliability and responsiveness to change of COPD-specific quality of life instruments like the SGRQ and the CRQ. 2 DCE studies were done in COPD: one on home care versus hospital care for a COPD-exacerbation and one on different components of the patient-experienced burden of disease.

Reimbursement dossiers

iMTA had contributed to reimbursement dossiers of tiotropium and roflumilast for COPD and varenicline for smoking cessation in the general population.