title: Generic utilities in chronic obstructive pulmonary disease patients stratified according to different staging systems.
abstract: BACKGROUND
  To determine generic utilities for Spanish chronic obstructive pulmonary disease (COPD) patients stratified by different classifications: GOLD 2007, GOLD 2013, GesEPOC 2012 and BODEx index.
  
  
  METHODS
  Multicentre, observational, cross-sectional study. Patients were aged ≥40 years, with spirometrically confirmed COPD. Utility values were derived from EQ-5D-3 L. Means, standard deviations (SD), medians and interquartile ranges (IQR) were computed based on the different classifications. Differences in median utilities between groups were assessed by non-parametric tests.
  
  
  RESULTS
  346 patients were included, of which 85.5% were male with a mean age of 67.9 (SD = 9.7) years and a mean duration of COPD of 7.6 (SD = 5.8) years; 80.3% were ex-smokers and the mean smoking history was 54.2 (SD = 33.2) pack-years. Median utilities (IQR) by GOLD 2007 were 0.87 (0.22) for moderate; 0.80 (0.26) for severe and 0.67 (0.42) for very-severe patients (p < 0.001 for all comparisons). Median utilities by GOLD 2013 were group A: 1.0 (0.09); group B: 0.87 (0.13); group C: 1.0 (0.16); group D: 0.74 (0.29); comparisons were statistically significant (p < 0.001) except A vs C. Median utilities by GesEPOC phenotypes were 0.84 (0.33) for non exacerbator; 0.80 (0.26) for COPD-asthma overlap; 0.71 (0.62) for exacerbator with emphysema; 0.72 (0.57) for exacerbator with chronic bronchitis (p < 0.001). Comparisons between patients with or without exacerbations and between patients with COPD-asthma overlap and exacerbator with chronic bronchitis were statistically-significant (p < 0.001). Median utilities by BODEx index were: group 0-2: 0.89 (0.20); group 3-4: 0.80 (0.27); group 5-6: 0.67 (0.29); group 7-9: 0.41 (0.31). All comparisons were significant (p < 0.001) except between groups 3-4 and 5-6.
  
  
  CONCLUSIONS
  Irrespective of the classification used utilities were associated to disease severity. Some clinical phenotypes were associated with worse utilities, probably related to a higher frequency of exacerbations. GOLD 2007 guidelines and BODEx index better discriminated patients with a worse health status than GOLD 2013 guidelines, while GOLD 2013 guidelines were better able to identify a smaller group of patients with the best health.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.forename: Alicia
authors.initials: A
authors.lastname: Huerta
authors.forename: José Alberto
authors.initials: JA
authors.lastname: Fernández-Villar
authors.forename: Bernardino
authors.initials: B
authors.lastname: Alcázar
authors.forename: Guillermo
authors.initials: G
authors.lastname: Villa
authors.forename: Carles
authors.initials: C
authors.lastname: Forné
authors.forename: Maribel
authors.initials: M
authors.lastname: Cuesta
authors.forename: Carlos
authors.initials: C
authors.lastname: Crespo
authors.forename: Francisco
authors.initials: F
authors.lastname: García-Río
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000465:Algorithms; D001007:Anxiety / Q000523:psychology*; D001249:Asthma; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009043:Motor Activity; D010146:Pain; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life; D013030:Spain; D011795:Surveys and Questionnaires