Development of a Conceptual Model of Disease Progression for Use in Economic Modeling of Chronic Obstructive Pulmonary Disease

Med Decis Making. 2017 May;37(4):440-452. doi: 10.1177/0272989X16662009. Epub 2016 Aug 2.


Background: To develop and validate a new conceptual model (CM) of chronic obstructive pulmonary disease (COPD) for use in disease progression and economic modeling. The CM identifies and describes qualitative associations between disease attributes, progression and outcomes.

Methods: A literature review was performed to identify any published CMs or literature reporting the impact and association of COPD disease attributes with outcomes. After critical analysis of the literature, a Steering Group of experts from the disciplines of health economics, epidemiology and clinical medicine was convened to develop a draft CM, which was refined using a Delphi process. The refined CM was validated by testing for associations between attributes using data from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE).

Results: Disease progression attributes included in the final CM were history and occurrence of exacerbations, lung function, exercise capacity, signs and symptoms (cough, sputum, dyspnea), cardiovascular disease comorbidities, 'other' comorbidities (including depression), body composition (body mass index), fibrinogen as a biomarker, smoking and demographic characteristics (age, gender). Mortality and health-related quality of life were determined to be the most relevant final outcome measures for this model, intended to be the foundation of an economic model of COPD.

Conclusion: The CM is being used as the foundation for developing a new COPD model of disease progression and to provide a framework for the analysis of patient-level data. The CM is available as a reference for the implementation of further disease progression and economic models.

Keywords: Conceptual model; Delphi Panel; chronic obstructive pulmonary disease (COPD); economic modeling; literature review.

MeSH terms

  • Biomarkers
  • Body Mass Index
  • Comorbidity
  • Delphi Technique
  • Disease Progression*
  • Health Services / statistics & numerical data
  • Health Status
  • Humans
  • Models, Economic
  • Models, Theoretical*
  • Pulmonary Disease, Chronic Obstructive / economics
  • Pulmonary Disease, Chronic Obstructive / mortality*
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Quality of Life
  • Quality-Adjusted Life Years
  • Respiratory Function Tests
  • Severity of Illness Index
  • Socioeconomic Factors


  • Biomarkers