Mapping and comparing COPD Care Pathways across 10 countries to understand barriers to optimal care: clinicians’ perspectives

Although predominantly preventable and treatable, chronic obstructive pulmonary disease (COPD) is a leading cause of death globally (1). Guidelines for managing the condition are widely available (2), yet, COPD care remains suboptimal in many settings, including high and middle-income countries (3).

Concerted regional or global efforts in COPD care may lead to important synergies in improving outcomes for patients across many healthcare settings. To achieve this, researchers and policymakers must gain a better understanding of the extent to which countries share common barriers.

Aquarius Population Health led a multifaceted project that used published literature and clinical guidelines to map the COPD care pathways in 10 countries: Argentina, Australia, Canada, England, Germany, Japan, Mexico, Russia, Spain, and Taiwan. To validate the pathways and understand how clinicians perceive barriers to optimal COPD care, we spoke to 41 healthcare professionals across all these countries. Finally, we combined all the data and compared the pathways, to see how different or similar are barriers to COPD among the studied countries.

The results of this work indicate that regardless of differences in economic development or healthcare systems among countries, many issues in COPD care are quite similar. Further efforts are needed to address these issues at a global level. The poster reporting this work is published at the 11th IPCRG World Conference and can be accessed here.

Shahaj O, Meiwald A, Gara-Adams R et al. “Mapping and comparing COPD Care Pathways across 10 countries to understand barriers to optimal care: clinicians’ perspectives.” Presented at: 11th IPCRG World Conference, May 5-7 2022; Virtual

1. Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020 Oct;396(10258):1204–22.

2. Singh D, Agusti A, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J [Internet]. 2019 May 1 [cited 2022 Jan 19];53(5). Available from: https://erj.ersjournals.com/content/53/5/1900164

3. Young M, Villgran V, Ledgerwood C, et al. Developing a Multidisciplinary Approach to the COPD Care Pathway. Crit Care Nurs Q. 2021 Mar;44(1):121–7.

Evidenced Care Pathways (ECPs) for chronic obstructive pulmonary disease in Japan, Canada, England, and Germany

Chronic obstructive pulmonary disease (COPD) is a preventable, progressive respiratory disease that causes considerable morbidity and mortality worldwide (1).

Despite the availability of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations for COPD management (2), there remains uncertainty around how care is currently delivered within individual countries and what barriers exist to the optimal delivery of COPD care.

Aquarius Population Health collaborated with AstraZeneca to create Evidenced Care Pathways (ECPs) to bring to life the story of how COPD care is currently delivered. Local data reviews and clinician interviews (twenty-four respiratory healthcare professionals in primary and secondary care) were used to inform and validate the ECPs.

The ECPs are a valuable tool in healthcare evaluation and were used to help identify the key barriers for optimal COPD care, and therefore opportunities for policy change – to improve disease awareness, care management and patient outcomes while reducing resource use and costs. The results of our research are published in the International Journal of Chronic Obstructive Pulmonary Disease] found here. These ECPs for COPD care in Japan, Canada, England, and Germany accompany the published paper.

Meiwald A, Gara-Adams R, Rowlandson A, et al. Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care. Int J Chron Obstruct Pulmon Dis. 2022;17:1507-1521 https://doi.org/10.2147/COPD.S360983

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1. Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis. J Glob Health. 2015;5(2):020415.

2. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2021 Report. 2021.

Care Pathway Mapping for Dravet Syndrome (DS) Patients in England

Dravet syndrome (DS) is a rare, early onset, lifelong, epileptic encephalopathy characterised by frequent and severe convulsive seizures. Finding effective treatments is imperative to reducing seizures and improving patient outcomes: DS is highly burdensome for both the patient and their family as well as the healthcare system.

It is important to understand how care is currently delivered to children and adults to improve care to meet the needs of DS patients. Aquarius Population Health presented the results of our pilot study at this year’s ILAE British Branch Virtual Annual Scientific Conference. We describe how care for people with DS is delivered across England and determine the utilisation of healthcare resources for the treatment of patients with DS, and the effects of seizure burden and age group.

Gara-Adams R, Mowlem F, Thomas RH, et al. Care Pathway Mapping for Dravet Syndrome (DS) Patients in England – interim results from a pilot study. Presented at: ILAE British Branch Virtual Annual Scientific Conference, September 23 – 24, 2021; Virtual

Analysing the COPD care pathway in Japan, Canada, England, and Germany: a global view

Chronic obstructive pulmonary disease (COPD) is a preventable, progressive respiratory disease that causes airflow blockage and breathing problems. COPD caused 3.23 million deaths in 2019 (1), affecting approximately 384 million people globally (2); and is associated with significant resource burden with global costs estimated to be US$2.1 trillion in 2010, rising to US$4.8 trillion by 2030 (3).

Despite the availability of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations for COPD management, there remains uncertainty around how care is currently delivered within individual countries and what barriers exist to optimal COPD care delivery.

Aquarius Population Health collaborated with AstraZeneca to present our research at a poster session at this year’s European Respiratory Society International Congress. Based on clinician interviews and local data reviews, our research advances our understanding of COPD care pathways in Japan, Canada, England, and Germany and identifies cross-cutting barriers to optimal COPD care. Opportunities for policy change were highlighted – to improve disease awareness, care management and patient outcomes while reducing resource use and costs.

Meiwald A, Gara-Adams R, Ma Y, et al. Analysing the COPD care pathway in Japan, Canada, England and Germany: a global view. Presented at: European Respiratory Society International Congress 2021, September 5 – 8, 2021; Virtual

1. WHO. Chronic obstructive pulmonary disease (COPD) fact sheet. 2021

2. Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis. J Glob Health. 2015 ;5(2):020415.

3. Bloom DE, Cafiero ET, Jané-Llopis E, et al. The Global Economic Burden of Noncommunicable Diseases. Geneva; 2011

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A Cost-Effectiveness Analysis of Fenfluramine for the Treatment of Seizures for Patients with Dravet Syndrome (DS) in the UK Setting

Dravet syndrome (DS) is a rare epileptic encephalopathy that is diagnosed in early infancy and extends through adulthood. Fenfluramine (FFA) is a recently licensed add-on therapy for the treatment of seizures in patients with DS aged 2 years and older.

This work presents a novel individual-level simulation modelling approach to calculate the cost-effectiveness of FFA compared with cannabidiol plus clobazam as an add-on therapy for DS patients in England. Results indicate that FFA is a cost-effective intervention.

Weston G, Pinsent A, Adams EJ, Linley W, Hawkins N, Schwenkglenks M, Hamlyn Williams C, Toward T. A Cost-Effectiveness Analysis of Fenfluramine for the Treatment of Seizures for Patients with Dravet Syndrome (DS) in the UK Setting. Presented at: International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2021 Congress, May 17 – 20, 2021; Virtual

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Determining the Relationship of Seizures, Seizure Free Days and Other Predictors of Health Related Quality of Life in Patients with Dravet Syndrome (DS) and Their Carers

Dravet syndrome (DS) is a rare, early onset, lifelong, epileptic encephalopathy characterised by frequent and severe convulsive seizures. The often-daily seizure episodes are associated with cognitive, motor, behavioural, and sleep impairments with substantial impairment and burden to the health-related quality of life (HRQoL) of patients, primary caregivers and family members.

This study explored the impact of increasing seizure free days (SFDs) on patients’ and carers’ HRQoL and examined and quantified the impact of clinical and epidemiological covariates to understand which factors may predict DS patient and carer HRQoL. The results showed that SFDs have a significant impact on QoL for both patients and carers; this suggests that treatment options that increase SFD can substantially impact both DS patients’ and carers’ QoL.

Pinsent A, Weston G, Adams EJ, Linley W, Hawkins N, Schwenkglenks M, Hamlyn Williams C, Toward T. Determining the Relationship of Seizures, Seizure Free Days and Other Predictors of Health Related Quality of Life in Patients with Dravet Syndrome (DS) and Their Carers. Presented at: International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2021 Congress, May 17 – 20, 2021; Virtual

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Evaluating the benefits and costs of using an mRNA versus DNA HR-HPV assay in the National Cervical Screening Programme in the Netherlands

Persistent infection with high-risk human papillomavirus (HR-HPV) is a leading cause of cervical cancer. The National Cervical Screening Programme (NCSP) implemented HR-HPV primary screening to detect HR-HPV infections in the Netherlands in 2017. The choice of HR-HPV test (mRNA or DNA) used in screening programmes can impact resource use and costs, follow-up testing and referral for colposcopy.

A decision tree model was adapted from a previously published model in England to represent the current cervical screening flowchart in the Netherlands. The model estimates the impact on costs, the number of colposcopies, HR-HPV and cytology tests of using an mRNA assay compared to a DNA assay for a cohort aged 30 to 65 years. Results found adopting an mRNA HR-HPV test instead of a DNA test as part of the NCSP in the Netherlands, gave an estimated €1.8M in total cost savings annually. The results from the model are comparable to results for other countries including England, Sweden, Denmark, Canada, and France.

Dombrowski C, Weston G, Adams E. Evaluating the benefits and costs of using an mRNA versus DNA HR-HPV assay in the National Cervical Screening Programme in the Netherlands. Poster presented at: EUROGIN International Multidisciplinary HPV Congress; 2021 May 30 – June 1; Virtual

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Modelling the impact of using a DNA compared to mRNA HPV assay as part of the cervical screening programmes in Sweden and Denmark

Nearly all cases of cervical cancer are caused by 14 high-risk human papillomavirus (HR-HPV) genotypes. Denmark and Sweden are assessing the structure of their cervical cancer screening programmes and implementing HR-HPV screening in certain populations. While both DNA and mRNA assays have similar sensitivity, mRNA assays have been shown to have higher specificity resulting in fewer false-positive results.

We adapted a decision tree model from a previously published study in England to explore how the type of assay used to detect HR HPV infections in a screening programme may impact costs, patient follow-up, and resource use. The results showed the use of mRNA tests in cervical screening for women in Sweden or Denmark instead of DNA testing would result in cost savings and a decrease in the number of unnecessary cytology tests, unnecessary recall HR-HPV tests and unnecessary colposcopies compared to HR-HPV DNA testing and can be used to inform the implementation of screening programmes with benefits for health services and women.

Dombrowski C, Weston G, Adams E. Modelling the impact of using a DNA compared to mRNA HPV assay as part of the cervical screening programmes in Sweden and Denmark. Poster presented at: EUROGIN International Multidisciplinary HPV Congress; 2021 May 30 – June 1; Virtual

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Estimating the costs and benefits of HR-HPV assay choice in a theoretical HPV primary cervical screening algorithm in Ontario, Canada

Current cervical screening program guidelines for Ontario recommend cytology testing every 3 years for ages 25-70. Primary HR-HPV screening has been found to be more sensitive than primary cytology in detecting high-grade disease of the cervix. As Canadian provinces and territories move towards implementing primary HR-HPV screening in their cervical screening programs, how cervical screening is organized and implemented will need to be considered, including the choice of HR-HPV assay as the type of test influences costs and resource use.

A published decision tree model based on the Cervical Screening Programme (CSP) in England was adapted to simulate the primary HPV algorithm proposed by the Cervical Screening Guideline Working Group in Ontario. Results showed using mRNA tests instead of DNA tests could save over CAD $4 million annually, and avoid approximately 11,000 unnecessary colposcopies, 15,000 HPV tests and 40,000 cytology tests. Whilst the Ontario algorithm has not yet been agreed upon, this study shows that the choice of HPV assay is an important consideration within an HPV primary cervical screening program.

Weston G, Steben M, Popadiuk C, Bentley J, Dombrowski C, Adams E. Estimating the costs and benefits of HR-HPV assay choice in a theoretical HPV primary cervical screening algorithm in Ontario, Canada. Poster presented at: EUROGIN International Multidisciplinary HPV Congress; 2021 May 30 – June 1; Virtual

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Evaluating the choice of HPV assay in the French cervical screening programme with a decision tree model

Persistent infection with high-risk human papillomavirus (HR-HPV) has been linked to precancerous lesions (cervical intraepithelial neoplasia (CIN)) which may progress to cervical cancer. Guidance was issued in 2020 in France to include the use of assays to detect HR-HPV infections in a national cervical screening programme.

A decision tree model was developed to evaluate the impact of using a similarly sensitive, but more specific, mRNA HR-HPV assay (Aptima HR-HPV assay) compared to a DNA HR-HPV test (cobas 4800 HPV assay) in the proposed cervical screening algorithm in France. Results showed using an mRNA assay could yield an estimated annual cost saving of €6.5 million and reduce the total number of colposcopies, HPV and cytology tests required. As mRNA and DNA assays have similar test sensitivity, true positives will not be missed, and total costs are reduced by eliminating unnecessary colposcopy referrals, HR-HPV and cytology tests.

Dombrowski C, Weston G, Descamps P, Izopet J, Adams E. Evaluating the choice of HPV assay in the French cervical screening programme with a decision tree model. Poster presented at: EUROGIN International Multidisciplinary HPV Congress; 2021 May 30 – June 1; Virtual.

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Project Type: Poster