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Copyright ©ERS Journals Ltd 2005
A dynamic population model of disease progression in COPD
1 Institute for Medical Technology Assessment (iMTA), Erasmus MC, Rotterdam. 2 Dept for Prevention and Health Services Research, National Institute of Public Health and the Environment (RIVM), Bilthoven, and 4 Dept of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands. 3 Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA.
CORRESPONDENCE: M. Hoogendoorn, Institute for Medical Technology Assessment, Erasmus MC, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Fax: 31 104089081. E-mail: e.hoogendoorn@erasmusmc.nl
Keywords: Chronic obstructive pulmonary disease, cost-effectiveness, disease severity, epidemiology, model, smoking cessation
Received: October 25, 2004
Accepted April 1, 2005
To contribute to evidence-based policy making, a dynamic Dutch population model of chronic obstructive pulmonary disease (COPD) progression was developed.
The model projects incidence, prevalence, mortality, progression and costs of diagnosed COPD by the Global Initiative for Chronic Obstructive Lung Disease-severity stage for 2000–2025, taking into account population dynamics and changes in smoking prevalence over time. It was estimated that of all diagnosed COPD patients in 2000, 27% had mild, 55% moderate, 15% severe and 3% very severe COPD. The severity distribution of COPD incidence was computed to be 40% mild, 55% moderate, 4% severe and 0.1% very severe COPD. Disease progression was modelled as decline in forced expiratory voume in one second (FEV1) % predicted depending on sex, age, smoking and FEV1 % pred. The relative mortality risk of a 10-unit decrease in FEV1 % pred was estimated at 1.2. Projections of current practice were compared with projections assuming that each year 25% of all COPD patients receive either minimal smoking cessation counselling or intensive counselling plus bupropion.
In the projections of current practice, prevalence rates between 2000–2025 changed from 5.1 to 11 per 1,000 inhabitants for mild, 11 to 14 per 1,000 for moderate, 3.0 to 3.9 per 1,000 for severe and from 0.5 to 1.3 per 1,000 for very severe COPD. Costs per inhabitant increased from \#8364;1.40 to 3.10 for mild, \#8364;6.50 to 9.00 for moderate, \#8364;6.20 to 8.50 for severe and from \#8364;3.40 to 9.40 for very severe COPD (price level 2000). Both smoking cessation scenarios were cost-effective with minimal counselling generating net savings.
In conclusion, the chronic obstructive pulmonary disease progression model is a useful instrument to give detailed information about the future burden of chronic obstructive pulmonary disease and to assess the long-term impact of interventions on this burden.
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