title: A Systematic Review of Health Economics Simulation Models of Chronic Obstructive Pulmonary Disease.
abstract: Many decision-analytic models with varying structures have been developed to inform resource allocation in chronic obstructive pulmonary disease (COPD).
  
  
  
  To review COPD models for their adherence to the best practice modeling recommendations and their assumptions regarding important aspects of the natural history of COPD.
  
  
  
  A systematic search of English articles reporting on the development or application of a decision-analytic model in COPD was performed in MEDLINE, Embase, and citations within reviewed articles. Studies were summarized and evaluated on the basis of their adherence to the Consolidated Health Economic Evaluation Reporting Standards. They were also evaluated for the underlying assumptions about disease progression, heterogeneity, comorbidity, and treatment effects.
  
  
  
  Forty-nine models of COPD were included. Decision trees and Markov models were the most popular techniques (43 studies). Quality of reporting and adherence to the guidelines were generally high, especially in more recent publications. Disease progression was modeled through clinical staging in most studies. Although most studies (n = 43) had incorporated some aspects of COPD heterogeneity, only 8 reported the results across subgroups. Only 2 evaluations explicitly considered the impact of comorbidities. Treatment effect had been mostly modeled (20) as both reduction in exacerbation rate and improvement in lung function.
  
  
  
  Many COPD models have been developed, generally with similar structural elements. COPD is highly heterogeneous, and comorbid conditions play an important role in its burden. These important aspects, however, have not been adequately addressed in most of the published models.
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: zafar.zafari@ubc.ca.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Zafari
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, University of British Columbia, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Stirling
authors.initials: S
authors.lastname: Bryan
authors.affiliation: Center for Heart and Lung Innovation (James Hogg Research Center), St. Paul's Hospital, Vancouver, British Columbia, Canada; Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; The PROOF Centre of Excellence, Vancouver, British Columbia, Canada.
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Tania
authors.initials: T
authors.lastname: Conte
authors.affiliation: The PROOF Centre of Excellence, Vancouver, British Columbia, Canada; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Rahman
authors.initials: R
authors.lastname: Khakban
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, University of British Columbia, Vancouver, British Columbia, Canada; Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Sadatsafavi
mesh_terms: D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D004470:Economics, Medical; D019983:Guideline Adherence; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000503:physiopathology; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
keywords: Markov models; chronic obstructive pulmonary disease; cost-effectiveness; discrete-event simulation; modeling