Table 6.

Key recommendations for future chronic obstructive pulmonary disease cost-effectiveness analyses and gaps in research

Recommendations for cost-effectiveness analyses of COPD treatments
Time horizon
Time horizon chosen should capture all relevant costs and effects and should reflect the chronic, progressive nature of COPD and its seasonal variability  The optimal time horizon depends on the outcomes. Preferably, include multiple time horizons, including policy-relevant time horizons of 4–5 years and lifetime
Population
The patients included should be patients for whom the therapy is indicated and should be representative of the broad real-life population
Comparator
The comparator should be usual care as seen in daily clinical practice
Costs
Use data sources from the same country and where possible standardize unit costs within a country  Minimum costs to include are medication costs and hospitalization costs
Outcomes
Distinguish between severe exacerbations (requiring hospitalization) and non-severe exacerbations (requiring GP/ED/specialist visit and short-course oral corticosteroids with or without antibiotics)  Incorporate separate utility estimates for stable periods and for during exacerbations  Ideally, include both a generic outcome (e.g. QALY) and a COPD-specific outcome
Model validation
If models are used, both internal and external validation is recommended. Preferably, use a standardized model validation tool
Gaps in cost-effectiveness analyses of COPD treatments
Incorporate comorbidity, when relevant  Incorporate adherence, when relevant  Incorporate side effects, when relevant  Validate long-term model outcomes using longitudinal real-life data  Cost effectiveness of treatment strategies as seen in real life (e.g. step-up or dose increase)  Establish MCID and WTP for COPD-specific outcomes

COPD chronic obstructive pulmonary disease, ED emergency department, GP general practitioner, MCID minimal clinically important difference, QALYs quality-adjusted life-years, WTP willingness to pay