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Title: Generic utilities in chronic obstructive pulmonary disease patients stratified according to different staging systems.
Author: Miravitlles Fernández, Marc
Huerta, Alicia
Fernández-Villar, José Alberto
Alcázar, Bernardino
Villa, Guillermo
Forné, Carles
Cuesta, Maribel
Crespo, Carlos
García Río, Francisco
Keywords: Malalties pulmonars obstructives cròniques
Economia de la salut
Chronic obstructive pulmonary diseases
Medical economics
Issue Date: 5-Sep-2014
Publisher: BioMed Central
Abstract: Background To determine generic utilities for Spanish chronic obstructive pulmonary disease (COPD) patients stratified by different classifications: GOLD 2007, GOLD 2013, GesEPOC 2012 and BODEx index. Methods Multicentre, observational, cross-sectional study. Patients were aged ≥40 years, with spirometrically confirmed COPD. Utility values were derived from EQ-5D-3 L. Means, standard deviations (SD), medians and interquartile ranges (IQR) were computed based on the different classifications. Differences in median utilities between groups were assessed by non-parametric tests. Results 346 patients were included, of which 85.5% were male with a mean age of 67.9 (SD = 9.7) years and a mean duration of COPD of 7.6 (SD = 5.8) years; 80.3% were ex-smokers and the mean smoking history was 54.2 (SD = 33.2) pack-years. Median utilities (IQR) by GOLD 2007 were 0.87 (0.22) for moderate; 0.80 (0.26) for severe and 0.67 (0.42) for very-severe patients (p < 0.001 for all comparisons). Median utilities by GOLD 2013 were group A: 1.0 (0.09); group B: 0.87 (0.13); group C: 1.0 (0.16); group D: 0.74 (0.29); comparisons were statistically significant (p < 0.001) except A vs C. Median utilities by GesEPOC phenotypes were 0.84 (0.33) for non exacerbator; 0.80 (0.26) for COPD-asthma overlap; 0.71 (0.62) for exacerbator with emphysema; 0.72 (0.57) for exacerbator with chronic bronchitis (p < 0.001). Comparisons between patients with or without exacerbations and between patients with COPD-asthma overlap and exacerbator with chronic bronchitis were statistically-significant (p < 0.001). Median utilities by BODEx index were: group 0<br>2: 0.89 (0.20); group 3<br>4: 0.80 (0.27); group 5<br>6: 0.67 (0.29); group 7<br>9: 0.41 (0.31). All comparisons were significant (p < 0.001) except between groups 3<br>4 and 5<br>6. Conclusion Irrespective of the classification used utilities were associated to disease severity. Some clinical phenotypes were associated with worse utilities, probably related to a higher frequency of exacerbations. GOLD 2007 guidelines and BODEx index better discriminated patients with a worse health status than GOLD 2013 guidelines, while GOLD 2013 guidelines were better able to identify a smaller group of patients with the best health.
Note: Reproducció del document publicat a:
It is part of: Health And Quality Of Life Outcomes, 2014, vol. 12, num. 9, p. 120
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ISSN: 1477-7525
Appears in Collections:Articles publicats en revistes (Genètica, Microbiologia i Estadística)

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