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Value Health. 2014 Jul;17(5):525-36. doi: 10.1016/j.jval.2014.03.1721. Epub 2014 May 14.

Cost-effectiveness models for chronic obstructive pulmonary disease: cross-model comparison of hypothetical treatment scenarios.

Author information

Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands. Electronic address:
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.
IMS Health, Health Economics and Outcomes Research, Real-World Evidence Solutions, London, UK.
The Swedish Institute for Health Economics, Lund, Sweden; Health Economics Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA.
The OLIN Studies, Luleå, Sweden.
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.
Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.



To compare different chronic obstructive pulmonary disease (COPD) cost-effectiveness models with respect to structure and input parameters and to cross-validate the models by running the same hypothetical treatment scenarios.


COPD modeling groups simulated four hypothetical interventions with their model and compared the results with a reference scenario of no intervention. The four interventions modeled assumed 1) 20% reduction in decline in lung function, 2) 25% reduction in exacerbation frequency, 3) 10% reduction in all-cause mortality, and 4) all these effects combined. The interventions were simulated for a 5-year and lifetime horizon with standardization, if possible, for sex, age, COPD severity, smoking status, exacerbation frequencies, mortality due to other causes, utilities, costs, and discount rates. Furthermore, uncertainty around the outcomes of intervention four was compared.


Seven out of nine contacted COPD modeling groups agreed to participate. The 5-year incremental cost-effectiveness ratios (ICERs) for the most comprehensive intervention, intervention four, was €17,000/quality-adjusted life-year (QALY) for two models, €25,000 to €28,000/QALY for three models, and €47,000/QALY for the remaining two models. Differences in the ICERs could mainly be explained by differences in input values for disease progression, exacerbation-related mortality, and all-cause mortality, with high input values resulting in low ICERs and vice versa. Lifetime results were mainly affected by the input values for mortality. The probability of intervention four to be cost-effective at a willingness-to-pay value of €50,000/QALY was 90% to 100% for five models and about 70% and 50% for the other two models, respectively.


Mortality was the most important factor determining the differences in cost-effectiveness outcomes between models.


COPD; cost-effectiveness; model; validation

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