title: External Validation of Health Economic Decision Models for Chronic Obstructive Pulmonary Disease (COPD): Report of the Third COPD Modeling Meeting.
abstract: OBJECTIVE
  To validate outcomes of presently available chronic obstructive pulmonary disease (COPD) cost-effectiveness models against results of two large COPD trials-the 3-year TOwards a Revolution in COPD Health (TORCH) trial and the 4-year Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) trial.
  
  
  METHODS
  Participating COPD modeling groups simulated the outcomes for the placebo-treated groups of the TORCH and UPLIFT trials using baseline characteristics of the trial populations as input. Groups then simulated treatment effectiveness by using relative reductions in annual decline in lung function and exacerbation frequency observed in the most intensively treated group compared with placebo as input for the models. Main outcomes were (change in) total/severe exacerbations and mortality. Furthermore, the absolute differences in total exacerbations and quality-adjusted life-years (QALYs) were used to approximate the cost per exacerbation avoided and the cost per QALY gained.
  
  
  RESULTS
  Of the six participating models, three models reported higher total exacerbation rates than observed in the TORCH trial (1.13/patient-year) (models: 1.22-1.48). Four models reported higher rates than observed in the UPLIFT trial (0.85/patient-year) (models: 1.13-1.52). Two models reported higher mortality rates than in the TORCH trial (15.2%) (models: 20.0% and 30.6%) and the UPLIFT trial (16.3%) (models: 24.8% and 36.0%), whereas one model reported lower rates (9.8% and 12.1%, respectively). Simulation of treatment effectiveness showed that the absolute reduction in total exacerbations, the gain in QALYs, and the cost-effectiveness ratios did not differ from the trials, except for one model.
  
  
  CONCLUSIONS
  Although most of the participating COPD cost-effectiveness models reported higher total exacerbation rates than observed in the trials, estimates of the absolute treatment effect and cost-effectiveness ratios do not seem different from the trials in most models.
authors.affiliation: Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands. Electronic address: hoogendoorn@imta.eur.nl.
authors.forename: Martine
authors.initials: M
authors.lastname: Hoogendoorn
authors.affiliation: Department for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Talitha L
authors.initials: TL
authors.lastname: Feenstra
authors.affiliation: IMS Health, Economics and Outcomes Research and Real-World Evidence Solutions, London, UK.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Asukai
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Briggs
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Ryan N
authors.initials: RN
authors.lastname: Hansen
authors.affiliation: Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich, Neuherberg, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Leidl
authors.affiliation: ICON Health Economics, Toronto, Ontario, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Risebrough
authors.affiliation: IMS Health, Economics and Outcomes Research and Real-World Evidence Solutions, London, UK.
authors.forename: Yevgeniy
authors.initials: Y
authors.lastname: Samyshkin
authors.affiliation: Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich, Neuherberg, Germany.
authors.forename: Margarethe
authors.initials: M
authors.lastname: Wacker
authors.affiliation: Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Maureen P M H
authors.initials: MP
authors.lastname: Rutten-van Mölken
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use; D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000379:methods* / Q000592:standards*; D003657:Decision Making; D004470:Economics, Medical; D005260:Female; D000068298:Fluticasone / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D000068299:Salmeterol Xinafoate / Q000191:economics* / Q000627:therapeutic use; D000069447:Tiotropium Bromide / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000069447:Tiotropium Bromide
keywords: COPD; cost-effectiveness; external validation; model