Patient-Centered Value Elements in the Economic Evaluation of Chronic Obstructive Pulmonary Disease (COPD): A Targeted Review of Cost-Effectiveness Analyses.

OBJECTIVE

We aimed to assess the extent to which economic evaluations of chronic obstructive pulmonary disease treatments incorporated patient-informed value elements (PIVEs) and value flower elements (VFEs), and to examine their association with economic outcomes.

METHODS

A targeted search of PubMed, Embase, and the Tufts Cost-Effectiveness Analysis Registry identified full-length economic evaluations of pharmacologic and non-pharmacologic chronic obstructive pulmonary disease treatments published between 2018 and 2026. Studies were reviewed for inclusion of PIVEs and VFEs. Wilcoxon rank-sum tests and exploratory linear regression analyses examined associations between PIVEs, VFEs, and economic outcomes.

RESULTS

Of 58 studies, 57 were cost-effectiveness or cost-utility analyses conducted from a healthcare system perspective (n = 49). Physical endurance was included in all studies, whereas other PIVEs, including side effects (n = 17), access to care (n = 17), explanation of benefits and risks (n = 13), new therapeutic options (n = 11), and willingness to pay (n = 5), were less commonly considered. Among VFEs, quality-adjusted life-years (n = 55) and net cost (n = 57) predominated, while adherence-improving factors (n = 18), productivity (n = 14), reduction in uncertainty (n = 3), and severity of disease (n = 1) were inconsistently incorporated. Only one study reported direct patient engagement. Exploratory analyses found no consistent association between inclusion of PIVEs or VFEs and economic outcomes.

CONCLUSIONS

Economic evaluations of chronic obstructive pulmonary disease treatments predominantly relied on net costs and quality-adjusted life-years, with limited incorporation of broader PIVEs or VFEs and rare patient engagement. The influence of broader value elements on economic outcomes remains uncertain. Future research should evaluate challenges to incorporating context-relevant PIVEs and VFEs and their implications for economic evaluation and healthcare decision making.