Are GOLD ABCD groups better associated with health status and costs than GOLD 1234 grades? A cross-sectional study.
OBJECTIVE
To investigate the association of the GOLD ABCD groups classification with costs and health-related quality of life (HR-QoL) and to compare this with the GOLD 1234 grades classification that was primarily based on lung function only.


METHODS
In a cross-sectional study, we selected patients diagnosed with chronic obstructive pulmonary disease (COPD) from electronic medical records of general practices. Multi-level analysis was used with costs (medication, primary care, healthcare, societal), diseasespecific and generic HR-QoL as independent variables. Either the new or the old GOLD stages were included in the analysis together with several covariates (age, gender, living situation, co-morbidity, self-efficacy, smoking, education, employment).


RESULTS
611 patients from 28 general practices were categorised as GOLD-A (n=333), GOLD-B (n=110), GOLD-C (n=80) and GOLD-D (n=88). Patients in the GOLD-B and GOLD-D groups had the highest prevalence of co-morbidities and the lowest level of physical activity, self-efficacy, and employment. The models with GOLD ABCD groups were more strongly related to and explained more variance in costs and in disease-specific and generic HR-QoL than the models with GOLD 1234 grades. The mean Clinical COPD Questionnaire score worsened significantly, with scores 1.04 (GOLD-B), 0.4 (GOLD-C) and 1.21 (GOLD-D) worse than for patients in GOLD-A. Healthcare costs per patient were significantly higher in GOLD-B (72%), GOLD-C (74%) and GOLD-D (131%) patients than in GOLD-A patients.


CONCLUSIONS
The GOLD ABCD groups classification is more closely associated with costs and HR-QoL than the GOLD 1234 grades classification. Furthermore, patients with GOLD-C had a better HR-QoL than those with GOLD-B but the costs of the two groups did not differ.
Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands • Department of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Melinde R S
MR
Boland
Apostolos
A
Tsiachristas
Annemarije L
AL
Kruis
Niels H
NH
Chavannes
Maureen P M H
MP
Rutten-van Mölken
D000368:Aged; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification* / Q000191:economics* / Q000503:physiopathology; D011788:Quality of Life