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ABC Index: quantifying experienced burden of COPD in a discrete choice experiment and predicting costs
  1. Lucas MA Goossens1,2,
  2. Maureen PMH Rutten-van Mölken1,2,
  3. Melinde RS Boland1,
  4. Bas Donkers2,3,
  5. Marcel F Jonker1,2,
  6. Annerika HM Slok4,
  7. Philippe L Salomé5,
  8. Onno CP van Schayck4,
  9. Johannes CCM in ’t Veen6,
  10. Elly A Stolk1,2,7
  11. on behalf of the research team that developed the ABC tool.
  1. 1Erasmus School of Health Policy and Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
  2. 2Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
  3. 3Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
  4. 4CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
  5. 5Huisartsencoöperatie PreventZorg, Bilthoven, The Netherlands
  6. 6Department of Pulmonology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
  7. 7EuroQol Foundation, Rotterdam, The Netherlands
  1. Correspondence to Dr Lucas MA Goossens; goossens{at}


Objective The Assessment of Burden of COPD (ABC) tool supports shared decision making between patient and caregiver. It includes a coloured balloon diagram to visualise patients’ scores on burden indicators. We aim to determine the importance of each indicator from a patient perspective, in order to calculate a weighted index score and investigate whether that score is predictive of costs.

Design Discrete choice experiment.

Setting and participants Primary care and secondary care in the Netherlands. 282 patients with chronic obstructive pulmonary disease (COPD) and 252 members of the general public participated.

Methods Respondents received 14 choice questions and indicated which of two health states was more severe. Health states were described in terms of specific symptoms, limitations in physical, daily and social activities, mental problems, fatigue and exacerbations, most of which had three levels of severity. Weights for each item-level combination were derived from a Bayesian mixed logit model. Weights were rescaled to construct an index score from 0 (best) to 100 (worst). Regression models were used to find a classification of this index score in mild, moderate and severe that was discriminative in terms of healthcare costs.

Results Fatigue, limitations in moderate physical activities, number of exacerbations, dyspnoea at rest and fear of breathing getting worse contributed most to the burden of disease. Patients assigned less weight to dyspnoea during exercise, listlessness and limitations with regard to strenuous activities. Respondents from the general public mostly agreed. Mild, moderate and severe burden of disease were defined as scores <20, 20–39 and ≥40. This categorisation was most predictive of healthcare utilisation and annual costs: €1368, €2510 and €9885, respectively.

Conclusions The ABC Index is a new index score for the burden of COPD, which is based on patients’ preferences. The classification of the index score into mild, moderate and severe is predictive of future healthcare costs.

Trial registration number NTR3788; Post-results.

  • chronic airways disease
  • primary care
  • respiratory medicine (see thoracic medicine)

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  • Contributors Acquisition of data: LMAG, MRSB, AHMS, JCCMiV and PLS. Analysis and interpretation of data: LMAG, BD and MFJ. Drafting or revising of article: LMAG, MPMHR-vM. Final approval of the manuscript: all authors.

  • Funding This work was supported by the Innovation Fund Dutch Health Insurers, Zeist, The Netherlands; Picasso for COPD, Alkmaar, The Netherlands; GlaxoSmithKline BV, Zeist, The Netherlands; Astra Zeneca BV, Zoetermeer, The Netherlands; Novartis BV, Arnhem, The Netherlands; Chiesi Pharmaceuticals BV, Rijswijk, The Netherlands; Almirall BV, Utrecht, The Netherlands.

  • Competing interests None declared.

  • Ethics approval Medical Ethics Committee of Atrium-Orbis-Zuyd Hospital, the Netherlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data may be used in consultation with the authors.

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