Abstract
We report the development, validation, and implementation of an open-source population-based outcomes model of chronic obstructive pulmonary disease (COPD) for Canada. Evaluation Platform in COPD (EPIC) is a discrete-event simulation model of Canadians 40 years of age or older. Three core features of EPIC are its open-population design (incorporating projections of future population growth, aging, and smoking trends), its incorporation of heterogeneity in lung function decline and burden of exacerbations, and its modeling of the natural history of COPD from inception. Multiple original data analyses, as well as values reported in the literature, were used to populate the model. Extensive face validity and internal and external validity evaluations were performed. The model was internally validated on demographic projections, mortality rates, lung function trajectories, COPD exacerbations, costs and health state utility values, and stability of COPD prevalence over time within strata of risk factors. In external validation, it moderately overestimated the rate of overall exacerbations in 2 independent trials but generated consistent estimates of rate of severe exacerbations and mortality. In its current version, EPIC does not consider uncertainty in the evidence. Several components such as additional (e.g., environmental and occupational) risk factors, treatment, symptoms, and comorbidity will have to be added in future iterations. Predictive validity of EPIC needs to be examined prospectively against future empirical studies. EPIC is the first multipurpose, open-source, outcome- and policy-focused model of COPD for Canada. Platforms of this type have the capacity to be iteratively updated to incorporate the latest evidence and to project the outcomes of many different scenarios within a consistent framework.
Highlights
We report the development, validation, and implementation of an open-source population-based outcomes model of Chronic Obstructive Pulmonary Disease (COPD) for Canada
By modeling the natural history of COPD from its inception, it is capable of modeling the outcomes of decisions across the entire care pathway of COPD
The following four features are the core components of the platform: 1) COPD should be modeled using the reference standard so that the model can make projections about the ‘true’ burden of COPD and the merits of screening/case detection strategies; 2) lung function trajectories and acute exacerbations are major factors impacting the natural history of COPD and should be simulated with high precision as they are ubiquitously the primary end points of clinical trials; 3) Evaluation Platform In COPD (EPIC) should realistically model heterogeneity in the natural history of COPD to enable modeling scenarios pertinent to Precision Medicine; 4) sex, age, and smoking, the three main risk factors for COPD, should be modeled explicitly
Summary
Validation, and implementation of an open-source population-based outcomes model of Chronic Obstructive Pulmonary Disease (COPD) for Canada. The prevalence of COPD is increasing in many jurisdictions. The prevalence of COPD has increased by 44.2% between 1990 and 2005(1). A Canadian study found the excess direct costs of COPD to be $5,947 (converted to 2015 Canadian dollars) per patient per year between 2001 and 2010, growing by more than 5% per year[6]. Canadian life tables with calibration to remove COPD-specific mortality. ܿ ݐݏൌ ߚଵ ൈ ܦܮܱܩଵ ߚଶ ൈ ܦܮܱܩଶ ߚଷ ൈ ܦܮܱܩଷ ߚସ ൈ ܦܮܱܩସ. Health state utility values in patients with COPD according to GOLD grades. ݕݐ݈݅݅ݐݑൌ ߚଵ ൈ ܦܮܱܩଵ ߚଶ ൈ ܦܮܱܩଶ ߚଷ ൈ ܦܮܱܩଷ ߚସ ൈ ܦܮܱܩସ
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