Table 3.

Consultation comments summary [1]

Theme	Detail
Population groups	Recommendations did not address the use of myCOPD specifically for the two modelled population groups: (1) people discharged from hospital following an acute exacerbation of COPD; and (2) people eligible for pulmonary rehabilitation
Powering of the TROOPER trial	The TROOPER trial of myCOPD PR versus face-to-face PR was adequately powered to show non-inferiority
Patient engagement	In the EAG report, the completion rate in the TROOPER trial was presented in a misleading way and that the concept of effective engagement had been ignored
Description of benefits	The benefits of myCOPD in trials and RWE were not properly acknowledged for the populations modelled
Economic model inputs	The uptake rate of myCOPD in the AECOPD model was thought to be inaccurate due to the RESCUE trial figure representing uptake to a clinical trial rather than the app itself. The EAG used a 46% uptake rate (reported in the RESCUE trial) [7]; a 48% uptake rate was suggested. Staff time in the economic models to represent registering people for myCOPD was too long and it was suggested it be reduced
Uncertainty in the cost modelling	The guidance appeared to overstate the effect of the uncertainties on whether myCOPD is cost saving or not. The EAG conducted sensitivity analysis to present this more clearly
Further research	There were several comments questioning why further research was necessary if the economic models showed a cost saving. It was unclear what research was needed
Patient-related considerations	It was stated that the patient expert was not representative of users. There was a lack of representation of NHS clinicians with sufficient experience of using myCOPD, particularly relating to PR. Only one of three invited clinicians were able to attend the initial MTAC meeting
Technology	Comments regarded updates to the app, accuracy of the data input and security of the data. The company responded to note all clinical information is automatically updated, and the app detects any possible error data input and meets all applicable security standards
Integration of myCOPD	There were questions around the integration of myCOPD with NHS systems. Healthcare professionals are able to track the use of myCOPD
Engagement	The consultee believed that the committee misunderstood adherence in the context of effective engagement and intervention. The company provided references to show how engagement is linked to behavioural change [23, 25] and agreed that understanding why people stop using the app could be an area of future research. Another comment questioned whether varying levels of engagement due to ill health could skew the data
Equalities	A healthcare professional queried if the use of myCOPD would increase health inequalities because of digital literacy and access to smart devices. Some people may need extra support to use the app. The company agreed further research is needed
Wording clarifications	Additional wording to be added regarding the care pathway description to ensure PR is covered. Wording changes around the technology and use were suggested

AECOPD acute exacerbations of chronic obstructive pulmonary disease, app application, COPD chronic obstructive pulmonary disease, EAG External Assessment Group, MTAC Medical Technologies Advisory Committee, NHS National Health Service, PR pulmonary rehabilitation, RWE real-world evaluations