The Cost-Effectiveness of a Personalised Early Warning Decision Support System (The COPDPredict™ System) to Predict and Prevent Acute Exacerbations of Chronic Obstructive Pulmonary Disease

James A Hall,1 Alice M Turner,2 Eleni Gkini,3 Rajnikant Mehta,4 Monica Spiteri,5 Neil Patel,5 Sue Jowett1 1Health Economics Unit, Department of Applied Health Sciences, University of Birmingham, Birmingham, UK; 2Department of Applied Health Sciences, University of Birmingham, Birmingham, UK; 3Birmingham Clinical Trials Unit, Department of Applied Health Sciences, University of Birmingham, Birmingham, UK; 4Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK; 5NEPESMO Ltd, London, UKCorrespondence: Sue Jowett, Email [email protected]: Chronic obstructive pulmonary disease (COPD) is a respiratory disease associated with significant morbidity, mortality, and healthcare burden. Many COPD patients are frequent exacerbators, which has a significant impact on patient prognosis. Prompt exacerbation management using a digital tool, COPDPredict™ may support COPD patients in identifying exacerbations earlier to reduce hospital admissions.Methods: Trial-based cost-utility and cost-effectiveness analyses from the UK National Health Service perspective compared the cost-effectiveness of COPDPredict™ with usual care for a COPD GOLD stage B and D cohort. A model-based analysis was also performed by extrapolating data from the trial to obtain the-cost-utility over a 5-year time horizon. The de-novo model was constructed using GOLD stages A–D as the health states.Results: The imputed trial-based analysis showed that at a willingness to pay £ 20,000 per quality-adjusted life-year (QALY), COPDPredict™ was 65% likely cost-effective in COPD B and D patients over 6-months with an incremental cost-effectiveness ratio (ICER) of £ 11,669/QALY (incremental cost +£ 238.16 (106.42), Incremental QALY +0.02 (0.012)). The results were robust to complete case analyses over 6- and 12-months. A similar ICER (£ 11,862/QALY) was obtained when performing model-based analysis over 5-years. Cost-effectiveness was sensitive to long-term effectiveness, cost parameters and alternative model structure, with expected value of information analyses suggesting a significant benefit from future research targeting the long-term effectiveness of the intervention.Conclusion: COPDPredict™ is potentially cost-effective for COPD B and D patients. However, the small samples sizes upon which the results were obtained warrant further investigation.Keywords: chronic obstructive pulmonary disease, respiratory medicine, self-management, digital health, cost-effectiveness analysis, decision modelling