Chronic Obstructive Pulmonary Disease (COPD),a global health crisis affecting over 350 million individuals and causing 3.2 million deaths annually, ranks as the third leading cause of death worldwide. This debilitating respiratory ailment, marked by persistent airflow limitation, shortness of breath, coughing, and sputum production, not only presents a significant disease burden but also imposes substantial economic costs.Projections estimate that COPD will cost the global economy INT$4.3 trillion between 2020 and 2050. As epidemiological research progresses, there is growing evidence suggesting that in-depth examination into the prevention and management of COPD is of paramount public health and economic importance. Discrete event simulation (DES) models are increasingly recognized as a vital tool in this endeavor, offering new avenues for understanding and addressing this complex disease.

Decision analysis models (DAMs) represent a crucial branch of operations research, integrating and analyzing diverse data sources to quantitatively assess various decisions. In the realm of public health,DAMs furnish scientific evidence to inform policy-making. With continuous advancements in COPD research, DAMs have become indispensable in managing the disease, simulating hypothetical scenarios, and offering practical evaluation and optimization strategies, particularly when real-world resources are constrained and clinical trial costs are high.

While Markov models and decision trees are commonly employed DAMs in COPD,they primarily address disease management at the population level,exhibiting limitations in handling patient heterogeneity and complex interactions. COPD is characterized by it’s high degree of heterogeneity and comorbidity.to better address individual differences and complexity, discrete event simulation (DES) models are gaining increasing attention from researchers seeking more nuanced and personalized approaches.

The DES model, also known as the event occurrence time model, is an individual-level operational research technique. It is characterized by its ability to flexibly simulate the dynamic behavior of complex systems and the interactions between individuals, groups, and their surroundings. Therefore, the DES model is ideally suited for addressing complex chronic diseases such as COPD. This simulation tool can overcome the limitations of conventional modeling approaches, enabling researchers to gain a deeper understanding of the natural disease progression of COPD, thereby better supporting decision-making and the implementation of effective health policies.

A systematic review was conducted to summarize the current submission status of DES in COPD research, revealing its potential in disease management and treatment effect evaluation. The review also proposes possible future research directions and identifies issues requiring further attention. While some studies have preliminarily explored the application of DES in COPD management, a extensive systematic review and evaluation were previously lacking. This review aims to provide valuable references for researchers and promote the advancement of personalized treatment and precise management of COPD.

Methodology: Ensuring Clarity and Reliability

the systematic review rigorously adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to ensure the clarity and reliability of the research. The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024563296). The complete review protocol, including detailed research questions, inclusion and exclusion criteria, and data extraction methods, is accessible in this database, providing a obvious and verifiable record of the research process.

Inclusion and Exclusion Criteria: Defining the Scope

Selecting appropriate inclusion and exclusion criteria is crucial for maintaining the integrity of a systematic review. By strictly defining these criteria, the relevance and quality of the included studies were maximized, thereby enhancing the credibility and scientific rigor of the systematic review. The specific inclusion criteria were: (i) studies that utilize formal decision analysis methods and implement DES in the COPD population, and (ii) studies that focus on applying DES in the domain of COPD.

The exclusion criteria were: (i) lack of a clear association between the DES model and COPD, (ii) qualitative studies, pure abstract papers, or purely methodological studies, and (iii) systematic reviews and/or meta-analyses. Studies that met the inclusion criteria were included in the review,while those that met any of the exclusion criteria were excluded,ensuring a focused and relevant selection of research.

Data Sources and Search Strategy: A Complete Approach

To ensure a comprehensive search, six databases were consulted: PubMed, Web of Science, Embase, Cochrane, EconLit, and China National knowledge Infrastructure (CNKI). Additionally,the references of included articles were manually searched to identify any relevant articles that might have been missed during the systematic search. The search period covered the inception of each database up to August 22, 2024, providing an up-to-date overview of the available literature.

The keywords and accessible terms used for the search included Chronic Obstructive Pulmonary Disease and discrete event simulation OR (discrete event) AND (computer simulation* OR model*). Boolean operators OR/AND were employed to diversify the search terms and capture a wide range of relevant studies.The search results were downloaded into EndNote for efficient management and analysis.

Study Selection: Refining the Results

After removing duplicate records using literature management software and manual verification, articles were screened based on titles and abstracts to exclude those irrelevant to the research objectives. Later, full-text reviews were performed on eligible studies to ensure they met the predefined criteria.Disagreements were resolved through consensus discussions between two reviewers, resulting in the final selection of included articles, ensuring a rigorous and unbiased selection process.

Data Extraction: Gathering Key Facts

Data extraction was performed by one author and verified by another to ensure accuracy and minimize errors. The extraction followed a pre-designed strategy, encompassing the following details: (i) Basic study facts: title, first author, publication year and country, abstract, and source of the literature, (ii) Research methodology: study population, data sources, model structure, parameter settings, model validation, simulation software, perspective, sensitivity analysis, and intervention scenarios, and (iii) Outcome measures: health-related indicators, cost-effectiveness indicators, and study conclusions. This comprehensive data extraction process ensured that all relevant information was captured and analyzed.

Quality Assessment: Ensuring Validity

To ensure the quality of the included studies, different quality assessment tools were used based on the study type. Two self-reliant reviewers scored all the studies and resolved differences through discussion. The final quality assessment results were recorded and reported to ensure transparency and reliability of the research, providing confidence in the validity of the findings.

Quality Assessment Using the CHEERS 2022 Checklist

Given that the articles included in this study are related to health economics, the International Society for Pharmacoeconomics and outcomes Research (ISPOR) recommends evaluating health economics research according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). In this study, two authors used the CHEERS 2022 checklist to assess the quality of the publications. Each CHEERS item was described as reported, not reported, or not applicable. CHEERS does not provide a specific scoring mechanism. Studies meeting 100% of the relevant CHEERS items are classified as demonstrating excellent quality, while those meeting 75%–99% are considered high quality.

Results: A Synthesis of Current Research

The systematic review synthesized findings from multiple studies to provide a comprehensive overview of the application of DES in COPD research. This synthesis focused on identifying key characteristics of the included studies and understanding the critical parameters used in model design, offering valuable insights into the current state of DES modeling in COPD management.

Characteristics of the Included Studies

the included studies exhibited a range of characteristics, including variations in study populations, data sources, and research methodologies. Understanding these characteristics is essential for interpreting the results of the review and identifying potential sources of heterogeneity. The review meticulously documented these characteristics to provide a clear and detailed picture of the existing research landscape.

Model Design: Key Parameters

The design of DES models involves the selection of key parameters that influence the simulation outcomes. These parameters may include disease progression rates, treatment effects, and healthcare costs.The review identified and analyzed the key parameters used in the included studies, providing insights into the factors that are considered most vital in modeling COPD management strategies. this analysis helps researchers understand the critical elements that drive the simulation results and inform decision-making.

Conclusion: The Future of COPD Research with DES

Discrete event simulation (DES) models are emerging as a promising tool in COPD research, offering the potential to enhance personalized treatment strategies and improve disease management. The systematic review highlights the current applications of DES in COPD and identifies areas for future research. As DES models continue to evolve and incorporate more patient-specific data, they are poised to play an increasingly critically important role in optimizing COPD care and reducing the global burden of this chronic respiratory disease.The insights gained from this review can guide researchers and policymakers in leveraging DES to develop more effective and cost-efficient interventions for COPD patients.

Understanding Discrete Event Simulation in COPD Research

Discrete Event Simulation (DES) has emerged as a valuable tool in health economics,particularly in the context of Chronic Obstructive Pulmonary Disease (COPD). A recent review examined nine studies that utilized DES to model and analyze various aspects of COPD management. These studies provide information to decision-makers by quantitatively assessing the short-term and long-term effects of different interventions under various hypothetical scenarios, aiming to maximize public health benefits.

Sensitivity Analysis and Results Validation

The robustness of these DES models is crucial for their practical application. Sensitivity analysis plays a key role in assessing how uncertainties in input parameters affect the model’s outcomes. While some studies employed simpler one-way sensitivity analysis (SSA), others adopted more comprehensive approaches, combining probabilistic sensitivity analysis (PSA) with SSA or deterministic sensitivity analysis (DSA). Notably, one study did not conduct any sensitivity analysis.

All nine studies validated their results to ensure reliability. three studies conducted internal validation only,while six studies combined both internal and external validation. These validation methods enhance the robustness and reliability of the study findings.

Economic Evaluation: Types, Perspectives, and discount Rates

The reviewed studies fall under the umbrella of health economics, providing quantitative assessments of interventions. Six studies focused on cost-utility analysis (CUA), while two studies conducted budget impact analysis (BIA) and comparative effectiveness research, respectively. One study combined CUA and cost-benefit analysis. Quality-Adjusted Life Years (QALYs) was the primary outcome measure used in the studies, with some also measuring other outcomes, including diagnostic rates, budget increments due to detection case strategies, and net benefits arising from different hypothetical scenarios.

The studies adopted different perspectives, influencing the scope of costs and benefits considered. Four studies adopted the healthcare perspective, three studies adopted the healthcare payer perspective, and two studies considered both the healthcare payer perspective and the societal perspective.

Discount rates, which account for the time value of money, varied across the studies. Five studies reported discount rates for effects and costs, ranging from 1.5% to 4%. Due to the relatively short time horizon of 5 years in one study, the discount rate for costs was 0%. Three studies did not report whether and how costs and effects were discounted.

Cost Composition in COPD Studies

Understanding the composition of costs is essential for informed decision-making. Among the nine studies, eight reported the composition of costs, with researchers including different costs based on their specific research objectives and perspectives. Three pharmacoeconomic studies considered not only the cost of the target drug but also the costs associated with pneumonia, which helps decision-makers make more accurate policy and resource allocation decisions. Additionally, some studies also accounted for specific costs related to pulmonary rehabilitation (PR) programs and case screening.

Interventions Analyzed: Pharmacological Therapy,Disease Detection,and Service Management

The studies analyzed a variety of interventions,which can be classified into three broad categories: pharmacological therapy,disease detection,and service management.

• Pharmacological Therapy: Three studies explored the impact of different pharmacological treatment regimens on COPD patients. One study primarily evaluated the long-term cost-effectiveness of tiotropium across various hypothetical scenarios and subgroups, revealing significant effects in reducing acute exacerbations and improving quality of life. Additionally,two other studies compared the health outcomes and overall healthcare costs of tiotropium/olodaterol fixed-dose combination (LAMA+LABA) therapy with both tiotropium monotherapy and the combination of long-acting β2 agonists/inhaled corticosteroids (LABA/ICS). The findings indicated that, for specific populations, tiotropium/olodaterol also significantly improved lung function and quality of life and demonstrated superior long-term cost-effectiveness. These studies provide robust economic evidence for stratified and personalized treatment of COPD.
• Disease Detection: One study provided a detailed account of the advancement and validation process of the EPIC assessment platform. Subsequently, two additional studies built upon this foundation by integrating early screening components and progressively explored the cost-effectiveness and budget impact of various early detection strategies. These screening strategies considered different risk populations and screening tools and various screening intervals. The findings indicate that, under a specific willingness-to-pay threshold, conducting COPD diagnostic questionnaires (CDQ) for all asymptomatic individuals is the most cost-effective option, though it requires a substantial budget. In contrast, screening high-risk individuals with a smoking history (aged ≥50) with CDQ achieves a better balance between cost-effectiveness and budget.
• Service Management: Three studies focused on the healthcare departments providing services to COPD patients through HCSO, considering patient dynamics readmissions. Among these, two studies explored and analyzed the impact of non-pharmacological PR strategies on COPD patient outcomes. they analyzed their role in capacity planning and resource reallocation within healthcare departments. The first study assessed post-exacerbation pulmonary rehabilitation (PEPR) strategies, aiming to provide decision-makers with more effective methods for COPD care while maintaining and improving care quality. The second study evaluated PR strategies under varying referral volumes, finding through different scenario simulations that increasing PR utilization is cost-effective and improves patient and operational outcomes. The third study incorporated pandemic-related components, using DES combined with regression models to assess the impact of different stringency indices on healthcare services for COPD patients during the pandemic. This study is valuable for understanding strategies to optimize healthcare service delivery during the pandemic.

model lineage: Disease Progression,Screening,and Health and Care System Operations

The DES models used in the reviewed studies can be categorized into three primary types: disease progression modeling,screening modeling,and health and care system operations. These categories reflect different approaches to simulating COPD and its management.

• Disease Progression Modeling: This approach utilizes traditional segmented methods to describe the natural history of diseases.
• Screening Modeling: This employs a comprehensive disease framework to assess the benefits of different screening strategies.
• Health and Care System Operations: This describes patient movement trajectories between healthcare departments.

Quality Assessment using the CHEERS 2022 Checklist

The quality of the included studies was assessed using the CHEERS 2022 checklist. Eight studies were evaluated,with scores ranging from 67.9% to 85.7%. Seven studies were classified as high quality (achieving 75%-99% of the items), and only one study was rated as medium quality (achieving 50%-74%). No studies were rated as poor quality. The included studies performed well in terms of quality assessment.

Quality Assessment Using ISPOR Practice Guidelines

Since one of the included studies was a Budget Impact analysis (BIA),which falls outside the scope of CHEERS quality assessment,the ISPOR Good practices for BIA guidelines were used to evaluate the quality of this study. Two authors independently assessed the study based on the nine items outlined in the ISPOR practice guidelines: perspective, time horizon, interventions and comparators, target population, data sources, cost inclusions, sensitivity analysis, discounting, and validation.

Results: A Synthesis of Current Research

through standardized searches across six databases and manual searches of reference lists, a total of 274 articles were obtained. After removing duplicates, 237 articles (86.5%) remained. Subsequently,titles and abstracts were screened,excluding 222 articles (93.7%) as their topics were not concentrated on DES and COPD-related research.

Fifteen articles underwent full-text review, of which six articles (40.0%) were excluded for the following reasons: two articles were systematic reviews, one article was a purely methodological study, and three articles only had abstracts available.Ultimately, nine articles were resolute to be included.

Characteristics of the Included Studies

The systematic review included nine studies.These studies were conducted in the UK (n=4),Canada (n=3),and France (n=1). Additionally, one study was conducted across Finland, Sweden, and the Netherlands. All studies were published in or after 2019, distributed as follows: three studies in 2019, one in 2020, three in 2021, one in 2022, and one in 2023.

According to the research objectives, the included studies are classified into three distinct model lineages. A detailed examination of the specific distinctions among these lineages is provided in the subsequent Model Lineage section.

Model Design: Key Parameters

Six selected studies focused on COPD patients as their target population,while three studies targeted the general population aged 40 and older. The sample sizes varied considerably depending on the research objectives, ranging from 563 individuals to the entire target population.

During the modelling process, researchers selected different modelling software. Six studies used general-purpose scripting languages (C++/R) for modelling, while three other studies employed specific DES software (Simul8). General-purpose scripting languages offer greater versatility but require coding and extensive debugging. In contrast, specialized software overcomes the limitations of programming languages, making the modelling process more streamlined and efficient.

Among the nine included studies, eight reported the simulation time horizons, ranging from one year to a lifetime. Three studies covered a lifetime. One study evaluated 20 years, a duration that can be considered equivalent to a lifetime span given that COPD is typically diagnosed in older individuals with shorter lifespans. The remaining four studies had time horizons between one and five years.

Among the nine included studies,three studies used only scenario sensitivity analysis (SSA),while two studies used only deterministic sensitivity analysis (DSA).

Conclusion: The Future of COPD research with DES

discrete Event Simulation models are proving to be a valuable asset in COPD research, offering a more nuanced understanding of the disease’s complexities and potential treatment strategies. As research continues, DES models promise to play an increasingly critically important role in shaping personalized treatment plans and improving the management of COPD on a global scale. The ability to simulate various scenarios and account for individual patient differences makes DES a powerful tool for researchers and policymakers alike, paving the way for more effective and efficient healthcare strategies in the fight against COPD.

A systematic review published in 2024 highlights the increasing use of Discrete Event Simulation (DES) models in managing Chronic Obstructive Pulmonary Disease (COPD). The review,encompassing nine studies published since March 2019,indicates a significant rise in DES-based models for COPD management,mirroring the broader growth of DES in healthcare.Supported by grants RF1028623262 and 2242024RCB0051, this research underscores DES’s potential to enhance COPD management and pinpoints key areas for future investigation.The review emphasizes the need for targeted evaluations based on specific medical and economic contexts to ensure the generalizability of evaluation results.

The review reveals that current research is primarily conducted in high-income countries, despite the fact that 90% of COPD-related deaths occur in low- and middle-income countries (LMICs). This disparity highlights a significant research gap, as limited epidemiological and clinical data, coupled with a shortage of medical resources in LMICs, currently preclude research from these areas. The authors suggest a need for targeted evaluations based on the specific medical and economic contexts of individual countries to ensure the generalizability of evaluation results.

The Role of DES in Health Economics Evaluation

The application of DES in COPD management falls under the category of health economics evaluation for several key reasons. First, DES is particularly well-suited for simulating complex medical processes and decision-making scenarios, allowing for patient-level modeling and analysis of COPD disease progression and care pathways. Given the limited healthcare resources in the real world,decision-makers often face conflicts when making decisions. In such cases,DES provides a systematic approach to evaluate the cost-effectiveness of different treatment options,helping to make optimal choices.

As one of the most prevalent and costly diseases globally, COPD not only imposes a severe health burden but also creates substantial financial pressure. thus, the health economics evaluation of COPD is critically important. This aligns with current research trends, as health economics evaluation has become an increasingly common research topic for DES in the healthcare field.

Time horizon Considerations in DES Modeling

For chronic diseases like COPD, the choice of time horizon is crucial. Different studies have employed varying time horizons based on their specific research objectives and application contexts. For instance,Yakutcan et al. chose a one-year time horizon to assess the impact of various policies on COPD management during the pandemic, allowing decision-makers to make rapid adjustments in a dynamic and rapidly changing surroundings.

In contrast, Mountain et al., in their assessment of screening strategies using BIA, selected a five-year time horizon, which aligns with the one to five years recommended by relevant guidelines. Standard CEA guidelines suggest using a sufficiently long (lifetime) time horizon to capture all outcomes. Though, Yakutcan’s team chose a three-year time horizon for their studies on the PR and PEPR projects, as these were not lifetime solutions for COPD and could not assess lifetime benefits indefinitely. The choice of time horizon for DES in COPD management exhibits considerable heterogeneity but is consistent with the research objectives and application contexts.

Pharmacological Interventions and Treatment Options

Studies on pharmacological interventions cover common categories of medications for COPD, ranging from monotherapy to combination therapy. All treatment options can improve patients’ lung function and quality of life, each with its applicable range and advantages. This is consistent with the GOLD 2024 guidelines.The studies included vary in their selected settings and perspectives, leading to differences in cost composition. However, they all reach a consistent conclusion that LAMA+LABA has significant advantages in improving health outcomes and reducing treatment costs for COPD patients and is thus recommended as a preferred treatment option, aligning with the NICE guidelines.

Though, current research does not consider triple therapy (LABA+LAMA+ICS). Even though existing studies have demonstrated that triple therapy can improve lung function and reduce exacerbations, its target population is high-risk patients and requires clinical review before use. Current studies mainly focus on patients with moderate to severe airflow obstruction. Therefore, future research on COPD drug interventions should address a broader patient population and evaluate the application of triple therapy.

Screening Strategies and Case Finding

Previous studies have shown that DES screening modeling has been widely applied in various disease areas, such as lung cancer and diabetes. Though, its application in COPD is relatively limited, which might potentially be due to the considerable heterogeneity of existing screening strategies. The studies included suggest that the most cost-effective scenario involves conducting CDQ screening every three years for all individuals aged 40 and above. In contrast, the US Preventive Services Task Force (USPSTF) tends to favor targeted case finding rather than population-wide screening. A recent study based in China, though, suggests that population screening strategies can be cost-effective.

There is no global consensus on which populations (general vs high-risk) should undergo COPD screening or how screening should be conducted (screening frequency, screening tools) at the primary and specialty care levels. Nonetheless, it is undeniable that case screening is a potential strategy for identifying undiagnosed COPD, leading to early interventions that can improve long-term health outcomes. When choosing an optimal strategy for COPD case finding, the criteria, accuracy, feasibility, and cost-effectiveness of approaches must be considered in relation to the operating environment, such as low-income versus high-income countries or different healthcare settings.

Pulmonary Rehabilitation and Telemedicine

COPD is a chronic disease, and patients may be hospitalized multiple times over a period. Yakutcan’s team developed an innovative approach that combines DES with the concept of patient readmission,demonstrating that the two critical non-pharmacological therapies,PR and PEPR,not only improve patients’ quality of life but also impact hospital healthcare management by reducing hospital stay and readmission rates,thereby enhancing overall hospital operational efficiency. This is consistent with current evidence on the effectiveness of PR and PEPR in treating COPD. Despite substantial evidence supporting the effectiveness of PR, its application remains significantly underutilized. The main reasons are insufficient awareness among professionals, payers, and patients regarding PR, as well as inadequate implementation of PR programs in healthcare facilities. Thus, future efforts should focus not only on increasing awareness of PR but also on promoting broader delivery methods, such as community-based or home-based PR.

during the COVID-19 pandemic, digital technology developed rapidly, and traditional face-to-face interaction services gradually shifted to remote care. Consequently, the telemedicine market became a safer choice for COPD management. This phenomenon also validated McKinstry’s earlier conclusion that global telemedicine has enormous potential in the field of COPD management.

Quality Assessment and Future Research Directions

Based on the CHEERS 2022 evaluation standards, seven studies were rated as high quality.The original CHEERS statement comprised 24 items, while the revised version incorporated an additional four items, totaling 28 items. In the review of the included literature, even though some studies considered the approach to engagement with patients and others affected by the study, none adequately addressed the other three newly added items: HEAPs, distributional effects, and the effect of engagement with patients and others affected by the study. This omission is primarily as most of the included studies were published before 2022 and thus did not fully adhere to the CHEERS 2022 evaluation standards. Future research should refer to the latest CHEERS statement to enhance the comprehensiveness and applicability of evaluations. Such as, adopting the core elements of HEAPs as persistent by expert Delphi consensus and making them publicly available as supplementary information can enhance the transparency and practicality of the research. Additionally, adopting patient and public involvement approaches could further strengthen the quality of the research.

Although this study has comprehensively and systematically assessed the potential of DES models in the management of COPD, their real-world application continues to face several challenges.Firstly, DES modeling is inherently complex, particularly in the context of chronic progressive diseases such as COPD. Modelers are required to abstract real-world processes and make numerous decisions, which directly influence both the construction of the model and the evaluation of outcomes. However, due to the abstract nature of the modeling process, researchers are often unable to capture all relevant details, which limits the transparency and reproducibility of the results. Secondly, DES operates at the individual level, necessitating not only high-quality and comprehensive data, but also placing greater demands on researchers. Along with clinical expertise, proficiency in simulation and programming is essential. Still, in practice, the accessibility and completeness of data are frequently limited, presenting challenges for researchers seeking to implement DES. Furthermore, many interventions, such as PR, telemedicine, and screening strategies, require substantial infrastructure investments. In resource-constrained countries and regions, the shortage of funding and equipment often constitutes a significant barrier to the implementation of these interventions.lastly, even though comorbidities play a critical role in COPD management, the studies included in this review generally fail to adequately address the impact of comorbid conditions. Comorbidities significantly influence both the outcomes and treatment effectiveness in COPD, thus, future research should prioritize the inclusion of comorbidities to enhance the external validity of the models.

This systematic review is the first to address the application of DES models in the management of COPD. By systematically evaluating and synthesizing the available evidence, this review offers a novel perspective on the role of DES in improving COPD management and identifies key areas for future research.

Conclusion

This review analyzes the current status of DES applications in the management of COPD and proposes future improvements, providing valuable information for research and resource allocation. The study results indicate that publications on the application of DES in COPD management have been steadily increasing since 2019, primarily focusing on interventions such as pharmaceuticals, screening strategies, and health service management from a health economics perspective. However, these studies are predominantly concentrated in a few high-income countries, which may limit the applicability of their results to low- and middle-income countries. Additionally, while the methods and reporting quality of these studies are generally adequate, there is still room for further advancement. The authors recommend that future researchers use the CHEERS 2022 checklist to improve the modeling process, ensuring the transparency and credibility of their research.

Understanding COPD: A Comprehensive Overview

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease that makes it difficult to breathe. The 2024 GOLD Report provides a detailed overview of COPD, covering its diagnosis, assessment, and management. It emphasizes the importance of assessing individual patient characteristics and disease severity to tailor treatment plans effectively.This comprehensive approach ensures that healthcare providers have the latest information to make informed decisions about patient care.

Personalized COPD Treatment Strategies

A key focus of the 2024 GOLD Report is the promotion of personalized treatment strategies for COPD patients. Recognizing the heterogeneity of the disease, the report underscores the need to move beyond a one-size-fits-all approach. By considering factors such as symptom burden, exacerbation frequency, and the presence of comorbidities, clinicians can develop individualized management plans that address the specific needs of each patient.

The report provides guidance on the selection of appropriate pharmacological and non-pharmacological interventions, emphasizing the importance of shared decision-making between patients and healthcare providers. This collaborative approach ensures that treatment goals align with patient preferences and values, ultimately leading to improved adherence and outcomes.

Economic modeling in COPD Management

The 2024 GOLD Report highlights the growing role of economic modeling in evaluating the cost-effectiveness of different COPD interventions. These models, which simulate the long-term health and economic consequences of various treatment strategies, can definitely help healthcare decision-makers make informed choices about resource allocation.

Several types of economic models are discussed in the report, including:

• Decision-analytic models: These models use decision trees or Markov models to compare the costs and benefits of different treatment options.
• discrete-event simulation (DES): DES models simulate the flow of patients through the healthcare system, allowing for the evaluation of different care pathways and resource utilization patterns.
• budget impact analysis: This type of analysis assesses the financial impact of adopting a new intervention or policy on a healthcare budget.

The report emphasizes the importance of using robust and clear modeling methods, adhering to established guidelines such as the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022). By employing these techniques, researchers and policymakers can gain valuable insights into the economic implications of COPD and identify opportunities to improve the efficiency and sustainability of healthcare systems.

The Global Burden of COPD

COPD is recognized as a leading cause of morbidity and mortality worldwide. the World Health Association (WHO) lists COPD among the top 10 causes of death globally. The 2024 GOLD Report acknowledges the significant burden of COPD, not only in terms of human suffering but also in terms of economic costs.

Studies have shown that COPD generates substantial costs for health systems, encompassing direct medical expenses such as hospitalizations, medications, and outpatient care, and also indirect costs associated with lost productivity and disability. The report underscores the need for effective prevention and management strategies to reduce the burden of COPD and improve the quality of life for affected individuals.

Conclusion

the 2024 GOLD Report provides a comprehensive and up-to-date overview of COPD management, emphasizing personalized treatment approaches and the use of economic modeling to inform healthcare decisions. By incorporating the recommendations outlined in this report, healthcare professionals, researchers, and policymakers can work together to improve the lives of individuals living with COPD and reduce the global burden of this debilitating disease.

The Missing Stakeholder Group: Why Patients Matter

Traditional health economic models often overlook a critical stakeholder group: patients. Van Voorn GA, Vemer P, Hamerlijnck D, et al., in their 2016 publication in *appl Health Econ Health Pol*, highlighted this gap, arguing that patient involvement is essential for creating more robust and relevant models.By incorporating patient perspectives, these models can better reflect the true value of healthcare interventions and policies.

The absence of patient input can lead to models that prioritize cost-effectiveness over patient-centered outcomes. Including patients ensures that models consider factors such as quality of life, treatment burden, and individual preferences, leading to more holistic and ethical healthcare decisions.

Discrete Event Simulation: A powerful Tool

Discrete event simulation (DES) is a valuable method for modeling complex healthcare systems. As noted by Karnon J,Stahl J,Brennan A,et al. in a 2012 *Med Decis Mak* report from the ISPOR-SMDM Modeling Good Research Practices Task Force,DES allows for the simulation of individual patient pathways and the evaluation of different interventions. Vázquez-Serrano JI, Peimbert-García RE, and Cárdenas-Barrón LE further emphasized the utility of DES in healthcare in their 2021 *Int J Environ Res Public Health* review.

DES can be used to model various aspects of healthcare, from patient flow in hospitals to the spread of infectious diseases. By incorporating patient-specific data and preferences, DES models can provide a more realistic and nuanced understanding of healthcare dynamics.

The evolution of Health economic Modeling

Health economic modeling has evolved significantly over the years. Eddy D. noted the need for bringing health economic modeling to the 21st century in a 2006 *Value health* article. The integration of electronic health records (EHRs),as discussed by Evans RS in a 2016 *Yearb of Inform* article,offers new opportunities for data-driven modeling.

EHRs provide a wealth of patient data that can be used to improve the accuracy and relevance of health economic models. This data can include patient demographics, medical history, treatment outcomes, and patient-reported outcomes, providing a comprehensive view of the patient experience.

COPD and Multimorbidity: A Complex Challenge

Chronic obstructive pulmonary disease (COPD) frequently enough occurs alongside other health conditions, a phenomenon known as multimorbidity.Fabbri LM, Celli BR, Agusti A, et al. highlighted this complex issue in a 2023 *Lancet Respir Med* article,emphasizing the need to recognize and address this “syndemic occurrence.”

Modeling COPD in the context of multimorbidity requires a elegant approach that considers the interactions between different diseases and their impact on patient outcomes.Patient involvement is particularly important in this context, as patients with multiple conditions often have complex and individual preferences for treatment.