Moretz Chad, Annavarapu Srinivas, Luthra Rakesh, Goldfarb Seth, Renda Andrew, Shaikh Asif, Kaila Shuchita
Comprehensive Health Insights, Louisville, KY, USA,
Boehringer Ingelheim, Ridgefield, CT, USA.
Int J Chron Obstruct Pulmon Dis. 2019 Feb 15;14:439-446. doi: 10.2147/COPD.S187947. eCollection 2019.
A claims-based model to predict patients likely to have undiagnosed COPD was developed by Moretz et al in 2015. This study aims to assess the performance of the aforementioned model using prospectively collected spirometry data.
A study population aged 40-89 years enrolled in a Medicare Advantage plan with prescription drug coverage or commercial health plan and without a claim for COPD diagnosis was identified from April 1, 2012 to March 31, 2016 in the Humana claims database. This population was stratified into subjects likely or unlikely to have undiagnosed COPD using the claims-based predictive model. Subjects were randomly selected for spirometry evaluation of FEV and FVC. The predictive model was validated using airflow limitation ratio (FEV/FVC <0.70).
A total of 218 subjects classified by the predictive model as likely and 331 not likely to have undiagnosed COPD completed spirometry evaluation. Those predicted to have undiagnosed COPD had a higher mean age (70.2 vs 67.9 years, =0.0012) and a lower mean FEV/FVC ratio (0.724 vs 0.753, =0.0002) compared to those predicted not to have undiagnosed COPD. Performance metrics for the predictive model were: area under the curve =0.61, sensitivity =52.5%, specificity =64.6%, positive predictive value =33.5%, and negative predictive value =80.1%.
The claims-based predictive model identifies those not at risk of having COPD eight out of ten times, and those who are likely to have COPD one out of three times.
莫雷茨等人于2015年开发了一种基于索赔数据的模型，用于预测可能患有未确诊慢性阻塞性肺疾病（COPD）的患者。本研究旨在使用前瞻性收集的肺功能测定数据评估上述模型的性能。
2012年4月1日至2016年3月31日期间，从哈门那索赔数据库中确定了年龄在40 - 89岁、参加了有处方药覆盖的医疗保险优势计划或商业健康计划且无COPD诊断索赔记录的研究人群。使用基于索赔的预测模型将该人群分为可能患有或不太可能患有未确诊COPD的受试者。随机选择受试者进行FEV和FVC的肺功能测定评估。使用气流受限率（FEV/FVC <0.70）对预测模型进行验证。
共有218名被预测模型分类为可能患有未确诊COPD的受试者和331名不太可能患有未确诊COPD的受试者完成了肺功能测定评估。与被预测为没有未确诊COPD的受试者相比，被预测为患有未确诊COPD的受试者平均年龄更高（70.2岁对67.9岁，P = 0.0012），平均FEV/FVC比值更低（0.724对0.753，P = 0.0002）。预测模型的性能指标为：曲线下面积 = 0.61，敏感性 = 52.5%，特异性 = 64.6%，阳性预测值 = 33.5%，阴性预测值 = 80.1%。
基于索赔的预测模型在十次中有八次能识别出没有患COPD风险的人，在三次中有一次能识别出可能患有COPD的人。
