ABC Index: quantifying experienced burden of COPD in a discrete choice experiment and predicting costs

Lucas M. A. Goossens*, Maureen P. M. H. Rutten-van Molken, Melinde R. S. Boland, Bas Donkers, Marcel F. Jonker, Annerika H. M. Slok, Philippe L. Salome, Onno C. P. van Schayck, Johannes C. C. M. In 't Veen, Elly A. Stolk, Res team developed ABC tool

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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 = 40. This categorisation was most predictive of healthcare utilisation and annual costs: sci1368, sci2510 and sci9885, 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.

Original languageEnglish
Article number017831
Number of pages10
JournalBMJ Open
Issue number12
Publication statusPublished - Dec 2017



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