Development and validation of the Evaluation Platform In COPD (EPIC): a population-based outcomes model of COPD for Canada

Abstract

BackgroundWe report the development, validation, and implementation of an open-source population-based outcomes model of Chronic Obstructive Pulmonary Disease (COPD) for Canada.\n\nMethodsEvaluation Platform in COPD (EPIC) is a discrete event simulation model of Canadians 40 years of age or older. Three core features of EPIC are its open-population design (incorporating projections of future population growth, aging, and smoking trends), its incorporation of heterogeneity in lung function decline and burden of exacerbations, and its modeling of the natural history of COPD from inception. Multiple original data analyses, as well as values reported in the literature, were used to populate the model. Extensive face validity as well as internal and external validity evaluations were performed.\n\nResultsThe model was internally validated on demographic projections, mortality rates, lung function trajectories, COPD exacerbations, and stability of COPD prevalence over time within strata of risk factors. In external validation, it moderately overestimated rate of overall exacerbations in two independent trials, but generated consistent estimates of rate of severe exacerbations and mortality.\n\nLimitationsIn its current version, EPIC does not consider uncertainty in the evidence. Several components such as additional (e.g., environmental and occupational) risk factors, treatment, symptoms, and comorbidity will have to be added in future iterations.\n\nConclusionsEPIC is the first multi-purpose outcome- and policy-focused model of COPD for Canada. By modeling the natural history of COPD from its inception, it is capable of modeling the outcomes of decisions across the entire care pathway of COPD. Platforms of this type have the capacity to be iteratively updated to incorporate the latest evidence and to project the outcomes of many different scenarios within a consistent framework.