A multistate model to evaluate COPD progression integrating drugs consumption data and hospital databases

Background: dealing with the increased costs related to the diagnosis and treatment of chronic-degenerative diseases requires a better knowledge of patients’ true care pathways. The study objective was to explore, using multi-state modeling, how analyses of drug prescriptions and data obtained from hospital discharge sheets can be used in combination to build a model of patients’ health care pathways in a non experimental setting. The model was applied to chronic obstructive Pulmonary disease (coPd). MeThods: Based on the goLd guidelines, access to hospitalization for coPd and prescription pharmaceuticals were awarded to seven transient, theoretically progressive states. The intensity of transitions was estimated with the non-parametric method proposed by aalen and Johansen for multi-state Markov models, non-homogeneous in time. resuLTs: The coPd patients included in the study totaled 111190. Patients admitted with a diagnosis of coPd without exacerbation had a growing probability over time of needing prescriptions for inhaled corticosteroids (Ics) or the set combination of long-acting beta-agonists (LaBa) and Ics; they also had a rising probability of an exacerbation. The use of Ics alone or in combination with LaBa delays hospital admission for acute respiratory failure by about 6 months, as compared to short-acting beta-agonists or anticholinergics. concLusIon: The probabilities of a transition and their distribution in relation to time, sex, age and clinical status can be a helpful tool to guide those operating in the health care sector who are called upon to carry out decisions from the standpoints of both efficacious clinical management and an efficient use of resources.