Correlation between disease severity factors and EQ-5D utilities in chronic obstructive pulmonary disease

Sexual dysfunction in women with chronic obstructive lung disease

OBJECTIVE

To determine the prevalence of sexual dysfunction in women with COPD and the factors related to its presence.

METHODS

Cross-sectional observational study during 2021, including women with COPD diagnosed by spirometry through convenience sampling. Data on age, smoking status, spirometric data, comorbidities and medications used were collected. A sexual health questionnaire was administered.

RESULTS

The study included 101 women with a mean age of 59.7 (11.3) years. All had experienced a change in sexual activity, with 44% attributing it to COPD. Among them, 51.5% experienced dyspnea during coitus. The prevalence of sexual dysfunction was 52.5%. Women with sexual dysfunction were older and had a lower Tiffeneau index. Furthermore, they consumed alcohol more frequently and had hypertension and cerebrovascular disease, and less often, they had diabetes and heart failure. However, they scored lower on the Charlson index corrected for age. Patients with sexual dysfunction used inhaled triple therapy less frequently.

CONCLUSIONS

Sexual dysfunction is common in women with COPD. Further studies are needed to investigate its causes, mechanisms, and potential treatments.

Value of Information Analysis of a Web-Based Self-Management Intervention for Chronic Obstructive Pulmonary Disease

Objective: Technology-based programs can be cost-effective in the management of chronic obstructive pulmonary disease (COPD). However, cost-effectiveness estimates always contain some uncertainty, and decisions based upon them carry some risk. We conducted a value of information (VOI) analysis to estimate the value of additional research of a web-based self-management intervention for COPD to reduce the costs associated with uncertainty. Methods: We used a 10,000-iteration cost-effectiveness model from the health care payer perspective to calculate the expected value of perfect information (EVPI) at the patient- and population-level. An opportunity loss was incurred when the web-based intervention did not produce a greater net monetary benefit than usual care in an iteration. We calculated the probability of opportunity loss and magnitude of opportunity costs as a function of baseline health utility. We aggregated opportunity costs over the projected incident population of inpatient COPD patients over 10 years and estimated it as a function of the willingness-to-pay (WTP) threshold. Costs are in 2022 U.S. Dollars. Results: Opportunity losses were found in 22.7% of the iterations. The EVPIpatient was $78 per patient (95% confidence interval: $75-$82). The probability that the intervention was the optimal strategy varied across baseline health utilities. The EVPIpopulation was $506,666,882 over 10 years for a WTP of $50,000. Conclusions: Research estimated to cost up to $500 million would be warranted to reduce uncertainty. Future research could focus on identifying the impact of baseline health utilities to maximize the cost savings of the intervention. Other considerations for future research priorities include implementation efforts for technology-based interventions.

Associations between the EQ-5D-5L and exacerbations of chronic obstructive pulmonary disease in the ETHOS trial

PURPOSE

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with deteriorating health and health-related quality of life (HRQoL) among people with COPD during and after events. HRQoL data are key to evaluating treatment cost-effectiveness and informing reimbursement decisions in COPD. EuroQoL 5-dimension 5-level (EQ-5D-5L) utility scores, based on various HRQoL measures, are used in economic evaluations of pharmacotherapy. These analyses estimated associations between EQ-5D-5L utility scores and exacerbations (new and previous) in patients with moderate-to-very severe COPD.

METHODS

Longitudinal mixed models for repeated measures (MMRM), adjusted for time and treatment, were conducted using data from the ETHOS study (NCT02465567); models regressed EQ-5D-5L on current and past exacerbations that occurred during the study, adjusting for other patient reported outcomes and clinical factors.

RESULTS

Based on the simplest covariate adjusted model (adjusted for current exacerbations and number of previous exacerbations during the study), a current moderate exacerbation was associated with an EQ-5D-5L disutility of 0.055 (95% confidence interval: 0.048, 0.062) with an additional disutility of 0.035 (0.014, 0.055) if the exacerbation was severe. After resolving, each prior exacerbation was associated with a disutility that persisted for the remainder of the study (moderate exacerbation, 0.014 [0.011, 0.016]; further disutility for severe exacerbation, 0.011 [0.003, 0.018]).

CONCLUSION

An EQ-5D-5L disutility of 0.090 was associated with a current severe exacerbation in ETHOS. Our findings suggest incorporating the effects of current, recently resolved, and cumulative exacerbations into economic models when estimating benefits and costs of COPD pharmacotherapy, as exacerbations have both acute and persistent effects.

Might Dog Walking Reduce the Impact of COPD on Patients' Life?

Low levels of physical activity (PA) lead to a worsening of physical condition and contributes to multimorbidity in Chronic Obstructive Respiratory Disease (COPD). Unsupervised PA related to dog ownership may contribute to reducing sedentary behavior. We aimed to investigate the relationship between dog walking, patient-reported outcomes (PROs) and exacerbations in COPD. A pre-defined sample of 200 COPD patients (dog owners and non-dog owners) with symptomatic COPD was sourced from a database representative of the Italian population. A computer-assisted personal interview was used to assess health status impairment (CAT), fatigue (FACIT), health-related quality of life (HRQoL) (EQ-5D), and PA frequency. In the whole sample, PA was associated with better CAT, EQ-5D, VAS, FACIT scores and reduced number of exacerbation (p < 0.001). Under the same CAT scores, dog-walking duration was associated with a better HRQoL (EQ5D, p = 0.015) and less fatigue (FACIT, p = 0.017). In an adjusted regression model, walking dogs >30 min was associated with lower fatigue (FACIT) than having no dogs and walking dogs <15 min (p = 0.026 and p = 0.009, respectively). Motivation related to dog walking could modify patients’ tendency to focus on symptoms during PA and, therefore, to perceive the fatigue. Dog walking may be effective for increasing and maintaining regular PA, reducing the subjective impact of COPD.

Health-related quality of life among adult patients with visual impairments in Yazd, Iran

BACKGROUND

Visual impairment (VI) is one of the major public health problems that cause suffering, disability, loss of productivity, and reduced quality of life (QoL). This study aimed to evaluate the health-related QoL (HRQoL) among adults with visual problems in 2021.

MATERIALS AND METHODS

This analytical cross-sectional study was conducted on 300 patients with VIs referring to ophthalmology centers in Yazd, Iran. Data were collected through face-to-face interviews using EQ-5D, visual analog scale (VAS), and demographic information questionnaires. The results were analyzed using independent sample t-test, one-way analysis of variance, Pearson correlation coefficient, and adjusted limited dependent variable mixture model (ALDVMM) model by STATA, and SPSS.

RESULTS

The mean and standard deviation of EQ-5D-5 L index and EQ-VAS score in the studied patients were 0.68 ± 0.25 and 72.46 ± 19.36, respectively. Most problems at unable/extreme level were related to the mobility dimension (12%) and the usual activities dimension (9%). Factors related to HRQoL scores using ALDVMM model showed that divorced or widow marital status, age over 50, having strabismus, and acuter visual problems had significant negative effects on EQ-5D-5 L index values (P < 0.05).

CONCLUSIONS

The results showed that HRQoL was moderate in patients with VIs and reduced in patients with high disease severity, old age, lack of a spouse, retirement, and nonuniversity education. As a result, socioeconomic and demographic characteristics were required to be considered in visual health policies.

Cost-effectiveness of Pulmonary Rehabilitation Among US Adults With Chronic Obstructive Pulmonary Disease

IMPORTANCE

Pulmonary rehabilitation (PR) after exacerbation of chronic obstructive pulmonary disease (COPD) is effective in reducing COPD hospitalizations and mortality while improving health-related quality of life, yet use of PR remains low. Estimates of the cost-effectiveness of PR in this setting could inform policies to improve uptake.

OBJECTIVE

To estimate the cost-effectiveness of participation in PR after hospitalization for COPD.

DESIGN, SETTING, AND PARTICIPANTS

This economic evaluation estimated the cost-effectiveness of participation in PR compared with no PR after COPD hospitalization in the US using a societal perspective analysis. A Markov microsimulation model was developed to estimate the cost-effectiveness in the US health care system with a lifetime horizon, 1-year cycle length, and a discounted rate of 3% per year for both costs and outcomes. Data sources included published literature from October 1, 2001, to April 1, 2021, with the primary source being an analysis of Medicare beneficiaries living with COPD between January 1, 2014, and December 31, 2015. The analysis was designed and conducted from October 1, 2019, to December 15, 2021. A base case microsimulation, univariate analyses, and a probabilistic sensitivity analysis were performed.

INTERVENTIONS

Pulmonary rehabilitation compared with no PR after COPD hospitalization.

MAIN OUTCOMES AND MEASURES

Net cost in US dollars, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio.

RESULTS

Among the hypothetical cohort with a mean age of 76.9 (age range, 60-92) years and 58.6% women, the base case microsimulation from a societal perspective demonstrated that PR resulted in net cost savings per patient of $5721 (95% prediction interval, $3307-$8388) and improved quality-adjusted life expectancy (QALE) (gain of 0.53 [95% prediction interval, 0.43-0.63] years). The findings of net cost savings and improved QALE with PR did not change in univariate analyses of patient age, the Global Initiative for Obstructive Lung Disease stage, or number of PR sessions. In a probabilistic sensitivity analysis, PR resulted in net cost savings and improved QALE in every one of 1000 samples and was the dominant strategy in 100% of simulations at any willingness-to-pay threshold. In a 1-way sensitivity analysis of total cost, assuming completion of 36 sessions, a single PR session would remain cost saving to $171 per session and had an incremental cost-effectiveness ratio of $884 per session for $50 000/QALY and $1597 per session for $100 000/QALY.

CONCLUSIONS AND RELEVANCE

In this economic evaluation, PR after COPD hospitalization appeared to result in net cost savings along with improvement in QALE. These findings suggest that stakeholders should identify policies to increase access and adherence to PR for patients with COPD.

Performance of the EQ-5D-5L Plus Respiratory Bolt-On in the Birmingham Chronic Obstructive Pulmonary Disease Cohort Study

OBJECTIVES

A respiratory bolt-on dimension for the EQ-5D-5L has recently been developed and valued by the general public. This study aimed to validate the EQ-5D-5L plus respiratory dimension (EQ-5D-5L+R) in a large group of patients with chronic obstructive pulmonary disease (COPD).

METHODS

Validation was undertaken with data from the Birmingham COPD Cohort Study, a longitudinal UK study of COPD primary care patients. Data on the EQ-5D-5L+R were collected from 1008 responding participants during a follow-up questionnaire in 2017 and combined with (previously collected) data on patient and disease characteristics. Descriptive and correlation analyses were performed on the EQ-5D-5L+R dimensions and utilities, in relation to COPD characteristics and compared with the EQ-5D-5L without respiratory dimension. Multivariate regression models were estimated to test whether regression coefficients of clinical characteristics differed between the EQ-5D-5L+R utility and the EQ-5D-5L utility.

RESULTS

Correlation coefficients for the EQ-5D-5L+R utility with COPD parameters were slightly higher than the EQ-5D-5L utility. Both instruments displayed discriminant validity but analyses in clinical subgroups of patients showed larger absolute differences in utilities for the EQ-5D-5L+R. In the multivariate analyses, only the coefficient for the COPD Assessment Test score was higher for the model using the EQ-5D-5L+R utility as outcome.

CONCLUSIONS

This study showed that the addition of a respiratory domain to the EQ-5D-5L led to small improvements in the instrument's performance. Comparability of the EQ-5D across diseases, currently considered one of its strengths, would have to be traded off against a modest improvement in utility difference when adding the respiratory dimension.

Burden of Disease Among Exacerbating Patients with COPD Treated with Triple Therapy in Spain

Background

The cost of chronic obstructive pulmonary disease (COPD) in Spain has been studied from different perspectives, but parameters such as the patient's phenotype have seldom been considered. Our aim was to describe the disease burden of COPD patients with frequent exacerbator phenotype, treated with triple therapy.

Methods

An observational, multicenter study was carried out from December 2017 to November 2018 in pulmonology services among patients ≥40 years with COPD confirmed diagnosis receiving triple therapy (ICS/LAMA/LABA) and history of ≥2 moderate or ≥1 severe exacerbation in the 12 months prior to the inclusion visit. COPD-related healthcare resources were collected over a 12-months period prior to the inclusion visit: pharmacological and non-pharmacological treatments, medical and ER visits, hospitalizations, tests and productivity loss. Costs were updated to €2019. Patients were classified according to blood eosinophil levels: <150 cells/µL and ≥150 cells/µL.

Results

A total of 306 patients were included (77.1% men), with mean age of 69.9 years. Mean COPD exacerbation rate was 2.5/patient/year and 51.3% of patients had ≥150 cells/µL eosinophil level. On average, for the total population, COPD-related visits/patients/year were 6.2. Resource use in moderate exacerbation was higher in patients with eosinophils ≥150 cells/µL, whereas in severe exacerbation was higher in patients with eosinophils <150cells/µL. According to eosinophil levels, total annual mean (SD) costs/patient accounted for €8382 (9863) and €5144 (5444) for patients with eosinophils <150 cells/µL and ≥150 cells/µL, respectively.

Conclusion

The impact of exacerbating COPD patients treated with triple therapy in Spain is large, especially among those with eosinophils <150 cells/µL.

[Quality of life in people with depression and physical comorbidity from a gender perspective]

OBJECTIVE

The aim of the study is to describe from a gender perspective how people with depression and physical comorbidity perceive their quality of life. The study included 380 people over 49 years of age with at least one of the following pathologies: diabetes, chronic obstructive pulmonary disease and ischemic heart disease. Participants were recruited from 31 teams the primary care of in Catalonia. Quality of life was measured using the EuroQol Scale. In addition, sociodemographic variables were collected, as well as the severity of depression, the index of economic deprivation and area of residence. The adjusted relationship between sex and dimensions of quality of life was assessed by means of multivariate logistic regression.

RESULTS

81.3% were women; the mean age was 68.4 years (SD: 8.8). The mean on the Visual Analogue Scale was 57.8 (SD: 17.4) in men and 55.8 (SD: 18.6) in women. The mean of the EQ-Health Index was 0.74 (SD: 0.17) in men and 0.65 (SD: 0.2) in women (p = 0.001). The probability of having problems of the EQ-5D showed sex as the most important factor (woman = 1/man = 0) in: self-care OR: 2.29 (95% CI 1.04-5.07) and daily activities OR: 3.09 (95% CI 1.67-5.71). Mobility was associated with age OR: 1.87 (95% CI 1.22-2.86), pain with area of residence OR: 2.51 (95% CI 1.18-5,34) and the BDI with anxiety/depression OR: 4,77 (95% CI 1.77-12,88).

CONCLUSION

The perception quality of life of women with depression and physical comorbidity is lower than that of men and, in both cases, it is lower than that of the general population.

Quality Assessment of an Integrated Care Pathway Using Telemonitoring in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease: Protocol for a Quasi-Experimental Study

Background

Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and are associated with a high morbidity and reduced quality of life (QoL). Although these diseases share similarities in symptoms and clinical course, and exacerbations of both diseases often overlap, care pathways for both conditions are usually not integrated. This results in frequent outpatient consultations and suboptimal treatment during exacerbations, leading to frequent hospital admissions. Therefore, we propose an integrated care pathway for both diseases, using telemonitoring to detect deterioration at an early stage and a single case manager for both diseases.

Objective

This study aims to investigate whether an integrated care pathway using telemonitoring in patients with combined CHF and COPD results in a higher general health-related QoL (HRQoL) as compared with the traditional care pathways. Secondary end points include disease-specific HRQoL, level of self-management, patient satisfaction, compliance to the program, and cost-effectiveness.

Methods

This is a monocenter, prospective study using a quasi-experimental interrupted time series design. Thirty patients with combined CHF and COPD are included. The study period of 2.5 years per patient is divided into a preintervention phase (6 months) and a postintervention phase (2 years) in which end points are assessed. The intervention consists of an on-demand treatment strategy based on monitoring symptoms related to CHF/COPD and vital parameters (weight, blood pressure, heart rate, oxygen saturation, temperature), which are uploaded on a digital platform. The monitoring frequency and the limit values of the measurements to detect abnormalities are determined individually. Monitoring is performed by a case manager, who has the opportunity for a daily multidisciplinary meeting with both the cardiologist and the pulmonologist. Routine appointments at the outpatient clinic are cancelled and replaced by telemonitoring-guided treatment.

Results

Following ethical approval of the study protocol, the first patient was included in May 2018. Inclusion is expected to be complete in May 2021.

Conclusions

This study is the first to evaluate the effects of a novel integrated care pathway using telemonitoring for patients with combined CHF and COPD. Unique to this study is the concept of remote on-demand disease management by a single case manager for both diseases, combined with multidisciplinary meetings. Moreover, modern telemonitoring technology is used instead of, rather than as an addition to, regular care.

Trial Registration

Netherlands Trial Register NL6741; https://www.trialregister.nl/trial/6741

International Registered Report Identifier (IRRID)

DERR1-10.2196/20571

Relationship Between Clinical Control, Respiratory Symptoms and Quality of Life for Patients with COPD

Background

The concept of clinical control has been proposed as an instrument for evaluating patients with COPD. However, the possible association between clinical control, reduced symptom severity and HRQoL has yet to be confirmed.

Methods

This multicentre, prospective and observational study was carried out in 15 pulmonology clinics in Spain. The patients were followed up for six months, with a baseline visit (V0), followed by visits at three months (V1) and six months (V2). Clinical control was determined at V1, with the application of both clinical criteria and the COPD assessment test (CAT). All patients reported their symptoms by a validated symptom diary (E-RS) using a portable device, and their HRQoL was assessed using the EQ5D questionnaire. The relationship between clinical control and E-RS and HRQoL during follow-up was assessed with t-test.

Results

A total of 126 patients were screened. After application of the inclusion/exclusion criteria, 93 were finally included (mean age 66 ± 8 years, 84.9% male), with a mean FEV₁ predicted of 49.8% ± 16.5%. Of these patients, 44 (47.3%) achieved clinical control at V1, according to CAT criteria, and 50 (53.8%), according to clinical criteria. The E-RS scores differed between controlled and uncontrolled patients at all time points, both according to CAT (mean differences of −4.6, −5.6 and −6.2 units at V0, V1 and V2, respectively, p<0.005 for all comparisons) and to clinical criteria (mean differences of −3.3, −5-6 and −4.99 units, respectively, p<0.005 for all comparisons). The controlled patients also presented a significantly better HRQoL, measured by the EQ5D questionnaire (mean difference 0.13 and 0.10 at V2 by CAT or clinical criteria, respectively, p<0.05).

Conclusion

Clinical control in patients with COPD, whether measured by CAT or by clinical criteria, is associated with a lower symptom load and a better HRQoL.

The Experience of COPD Patients in Lockdown Due to the COVID-19 Pandemic

Purpose

On March 16, 2020, the Spanish government declared a state of alarm due to the rapid spread of coronavirus disease 2019 (COVID-19). Patients with chronic obstructive pulmonary disease (COPD) were restricted to remain confined at home, and medical visits were cancelled for 3 months. The impact of this lockdown on the manifestations of COPD and the quality-of-life of these patients has not been explored.

Patients and Methods

One hundred patients with COPD were interviewed by telephone from May 2–18, 2020. The interviews included questions about the lockdown, missed medical appointments, fears of the disease, possible COVID-19 infection, and exacerbations of COPD suffered during this period and their management. In addition, the COPD Assessment Test, the Hospital Anxiety and Depression, and the 5-Dimension Euro Quality-of-Life questionnaires were administered.

Results

Sixty-four (64%) patients claimed to have strictly complied with the lockdown, and only 42 (42%) stated they had left home at least once during lockdown. Only one patient (1%) was hospitalized due to COVID-19, and 13 (13%) patients presented an exacerbation of COPD self-managed at home with no admissions due to exacerbation of COPD during this period. A medical consultation or complementary test was cancelled in 90% of the patients, but 61% had a medical telephone visit with a high degree of satisfaction (mean 9.3/10). Most patients declared that their feeling regarding lung disease and general health was similar or even better during lockdown (82% and 81%, respectively).

Conclusion

Our results indicate that in general lockdown had a low impact on COPD patients. Only one patient was affected by COVID-19, but moderate exacerbations of COPD were not infrequent. Although many medical visits and test were cancelled, patients were very satisfied with the medical telephone visits.

Polyunsaturated fatty acids, lung function, and health-related quality of life in patients with chronic obstructive pulmonary disease

Background

Dietary polyunsaturated fatty acids (PUFA) are thought to modify systemic inflammation. The present study aimed to evaluate the relationship between PUFA intake, lung function, and health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD).

Methods

In this study, we used the dataset of 6th Korea National Health and Nutrition Examination Survey, in which, a total of 22,948 individuals including 573 participants with a high probability of developing COPD were enrolled. Participants with missing data for the investigated variables were excluded. Linear regression analyses were used to evaluate the association between PUFA intake (omega-3 [N3], omega-6 [N6], and total) with lung function, and HRQoL. HRQoL was determined according to the European Quality of Life-5 Dimensions (EQ-5D). Subgroup analysis of older patients was performed. Age, sex, body mass index, smoking, alcohol, education, residence, total calorie intake, and predicted FEV₁% were adjusted in all analyses.

Results

Although lung function was not associated with PUFA intake, EQ-5D index was remarkably associated with N3, N6, and total PUFA intake in a dose-dependent manner. This association was more pronounced in elderly COPD patients. Mean levels of N3, N6, and total PUFA intake were significantly higher in patients having better HRQoL with respect to mobility, self-care, and usual activities.

Conclusion

Our results suggest that N3, N6, and total PUFA intake are associated with HRQoL in COPD patients. This association may be attributed to mobility, self-care, and usual activities. Further longitudinal study is required to clarify this relationship.