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3. External Validation Of The Updated ADO Score In COPD Patients From The Birmingham COPD Cohort

Author

Keene, Spencer J, Jordan, Rachel E, Franssen, Frits ME, de Vries, Frank, Martin, James, Sitch, Alice, Turner, Alice Margaret, Dickens, Andrew P, Fitzmaurice, David, Adab, Peymane, Pulmonologie, RS: NUTRIM - R3 - Respiratory & Age-related Health, MUMC+: DA KFT Medische Staf (9), Farmacologie en Toxicologie, RS: CAPHRI - R5 - Optimising Patient Care, Afd Pharmacoepi & Clinical Pharmacology, and Pharmacoepidemiology and Clinical Pharmacology

Subjects
Adult, Male, Time Factors, PREDICTION, MODELS, Vital Capacity, International Journal of Chronic Obstructive Pulmonary Disease, OBSTRUCTIVE PULMONARY-DISEASE, Risk Assessment, Decision Support Techniques, Pulmonary Disease, Chronic Obstructive, Predictive Value of Tests, Risk Factors, Forced Expiratory Volume, Prevalence, Humans, Registries, Lung, INDEX, Original Research, pulmonary disease, validation studies, Aged, Aged, 80 and over, chronic obstructive, Primary Health Care, DEATH, Age Factors, Reproducibility of Results, Middle Aged, Prognosis, mortality, Dyspnea, England, Female, prognosis
Abstract

Spencer J Keene,1–3 Rachel E Jordan,1 Frits ME Franssen,3,4 Frank de Vries,2,5 James Martin,1 Alice Sitch,1,6 Alice Margaret Turner,1 Andrew P Dickens,1 David Fitzmaurice,7 Peymane Adab1 1Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; 2Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands; 3Ciro, Horn, the Netherlands; 4Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands; 5Utrecht Institute for Pharmaceutical Sciences Utrecht University, Utrecht, The Netherlands; 6NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; 7Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UKCorrespondence: Rachel E JordanInstitute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UKTel +44 0121 414 6775Email r.e.jordan@bham.ac.ukBackground: Reviews suggest that the ADO score is the most discriminatory prognostic score for predicting mortality among chronic obstructive pulmonary disease (COPD) patients, but a full evaluation and external validation within primary care settings is critical before implementation.Objectives: To validate the ADO score in prevalent and screen-detected primary care COPD cases at 3 years and at shorter time periods.Patients and methods: One thousand eight hundred and ninety-two COPD cases were recruited between 2012 and 2014 from 71 United Kingdom general practices as part of the Birmingham COPD Cohort study. Cases were either on the practice COPD register or screen-detected. We validated the ADO score for predicting 3-year mortality with 1-year and 2-year mortality as secondary endpoints using discrimination (area-under-the-curve (AUC)) and calibration plots.Results: One hundred and fifty-four deaths occurred within 3 years. The ADO score was discriminatory for predicting 3-year mortality (AUC= 0.74; 95% CI: 0.69–0.79). Similar performance was foundfor 1- (AUC= 0.73; 0.66–0.80) and 2-year mortality (0.72; 0.67–0.76). The ADO score showed reasonable calibration for predicting 3-year mortality (calibration slope 0.95; 0.70–1.19) but over-predicted in cases with higher predicted risks of mortality at 1 (0.79; 0.45–1.13) and 2-year (0.79; 0.57–1.01) mortality.Discussion: The ADO score showed promising discrimination in predicting 3-year mortality in a primary care population including screen-detected cases. It may need to be recalibrated if it is used to provide risk predictions for 1- or 2-year mortality since, in these time-periods, over-prediction was evident, especially in cases with higher predicted mortality risks.Keywords: pulmonary disease, chronic obstructive, mortality, prognosis, validation studies

Published
2019

5. Cost-effectiveness of domiciliary non-invasive ventilation in patients with chronic obstructive pulmonary disease.

Author

Hall, James, Turner, Alice Margaret, Dretzke, Janine, Moore, David, and Jowett, Sue

Subjects
CHRONIC obstructive pulmonary disease, NONINVASIVE ventilation
Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a chronic disease associated with recurring exacerbations, which influence morbidity and mortality for the patient, while placing significant resource burdens on healthcare systems. Non-invasive ventilation (NIV) in a domiciliary setting can help prevent admissions, but the economic evidence to support NIV use is limited.Methods: A Markov model-based cost-utility analysis from the UK National Health Service perspective compared the cost-effectiveness of domiciliary NIV with usual care for two end-stage COPD populations; a stable COPD population commencing treatment with no recent hospital admission; and a posthospital population starting treatment following admission to hospital for an exacerbation. Hospitalisation rates in patients receiving domiciliary NIV compared with usual care were derived from randomised controlled studies in a recent systematic review. Other model parameters were updated with recent evidence.Results: At the threshold of £20 000 per quality-adjusted life-year (QALY) domiciliary NIV is 99.9% likely cost-effective in a posthospital population, but unlikely (4%) to be cost-effective in stable populations. The incremental cost-effective ratio (ICER) was £11 318/QALY gained in the posthospital population and £27 380/QALY gained in the stable population. Cost-effectiveness estimates were sensitive to longer-term readmission and mortality risks, and duration of benefit from NIV. Indeed, for stable Global Initiative for Chronic Obstructive Lung Disease (GOLD) for stage 4 patients, or with higher mortality and exacerbation risks, ICERs were close to the £20 000/QALY threshold.Conclusion: Domiciliary NIV is likely cost-effective for posthospitalised patients, with uncertainty around the cost-effectiveness of domiciliary NIV in stable patients with COPD on which further research should focus. [ABSTRACT FROM AUTHOR]

Published
2022
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7. Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care

Author

Lambe, Tosin, primary, Adab, Peymane, additional, Jordan, Rachel E, additional, Sitch, Alice, additional, Enocson, Alex, additional, Jolly, Kate, additional, Marsh, Jen, additional, Riley, Richard, additional, Miller, Martin, additional, Cooper, Brendan G, additional, Turner, Alice Margaret, additional, Ayres, Jon G, additional, Stockley, Robert, additional, Greenfield, Sheila, additional, Siebert, Stanley, additional, Daley, Amanda, additional, Cheng, KK, additional, Fitzmaurice, David, additional, and Jowett, Sue, additional

Published
2019
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8. External Validation Of The Updated ADO Score In COPD Patients From The Birmingham COPD Cohort

Author

Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, Keene, Spencer J, Jordan, Rachel E, Franssen, Frits Me, de Vries, Frank, Martin, James, Sitch, Alice, Turner, Alice Margaret, Dickens, Andrew P, Fitzmaurice, David, Adab, Peymane, Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, Keene, Spencer J, Jordan, Rachel E, Franssen, Frits Me, de Vries, Frank, Martin, James, Sitch, Alice, Turner, Alice Margaret, Dickens, Andrew P, Fitzmaurice, David, and Adab, Peymane

Published
2019

9. External Validation Of The Updated ADO Score In COPD Patients From The Birmingham COPD Cohort

Author

Keene,Spencer J, Jordan,Rachel E, Franssen,Frits ME, de Vries,Frank, Martin,James, Sitch,Alice, Turner,Alice Margaret, Dickens,Andrew P, Fitzmaurice,David, Adab,Peymane, Keene,Spencer J, Jordan,Rachel E, Franssen,Frits ME, de Vries,Frank, Martin,James, Sitch,Alice, Turner,Alice Margaret, Dickens,Andrew P, Fitzmaurice,David, and Adab,Peymane

Abstract

Spencer J Keene,1–3 Rachel E Jordan,1 Frits ME Franssen,3,4 Frank de Vries,2,5 James Martin,1 Alice Sitch,1,6 Alice Margaret Turner,1 Andrew P Dickens,1 David Fitzmaurice,7 Peymane Adab1 1Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; 2Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands; 3Ciro, Horn, the Netherlands; 4Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands; 5Utrecht Institute for Pharmaceutical Sciences Utrecht University, Utrecht, The Netherlands; 6NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; 7Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UKCorrespondence: Rachel E JordanInstitute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UKTel +44 0121 414 6775Email r.e.jordan@bham.ac.ukBackground: Reviews suggest that the ADO score is the most discriminatory prognostic score for predicting mortality among chronic obstructive pulmonary disease (COPD) patients, but a full evaluation and external validation within primary care settings is critical before implementation.Objectives: To validate the ADO score in prevalent and screen-detected primary care COPD cases at 3 years and at shorter time periods.Patients and methods: One thousand eight hundred and ninety-two COPD cases were recruited between 2012 and 2014 from 71 United Kingdom general practices as part of the Birmingham COPD Cohort study. Cases were either on the practice COPD register or screen-detected. We validated the ADO score for predicting 3-year mortality with 1-year and 2-year mortality as secondary endpoints using discrimination (area

Published
2019

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