Combined Therapy for Stable COPD Proves Cost-Effective in Simulation Model

Combined Traditional Chinese Medicine and Western medicine therapy for stable chronic obstructive pulmonary disease demonstrated high cost-effectiveness in a discrete event simulation model developed from a Chinese healthcare system perspective. Parameterized with clinical trial data, the health economic evaluation revealed that the combined approach yielded an incremental cost-utility ratio of 7,467 RMB per quality-adjusted life year compared with Traditional Chinese Medicine alone. At a willingness-to-pay threshold of 85,698 RMB per quality-adjusted life year, representing one time China’s per-capita gross domestic product, probabilistic sensitivity analysis across 400 iterations showed a 98.5 percent probability that combined therapy was cost-effective, while Western medicine alone was dominated.

Researchers developed the discrete event simulation model specifically to evaluate stable chronic obstructive pulmonary disease patients aged 18 to 80 years. Across a two-year time horizon, the longitudinal outcomes in the simulation were updated every three months using multilevel mixed-effects models alongside Weibull regression. Costs within the model were originally estimated in 2013 RMB and subsequently adjusted to 2022 values using the China Consumer Price Index.

The simulation architecture integrated 24 baseline variables to project disease trajectories and economic outcomes over time. In monitoring disease progression, the model incorporated six intermediate clinical outcomes: forced expiratory volume in one second (FEV1), six-minute walk distance (6MWD), dyspnea, cough, sputum, and the COPD-PRO instrument. Acute exacerbation served as the final clinical outcome, while health outcomes were quantified as quality-adjusted life years to serve as the primary measure for the economic evaluation.

In the three-month base-case analysis, patients with chronic obstructive pulmonary disease experienced measurable clinical improvements. The model recorded a mean increase of 6.8 meters in the six-minute walk distance, a reduction of 0.25 acute exacerbations, and improvements across symptom scores. Across the full two-year horizon, the mean total cost was 12,726.18 RMB.

The evaluation contrasted three distinct treatment pathways: Western medicine, Traditional Chinese Medicine, and combined therapy. Cost-utility ratios were calculated at 5,066.79 RMB per quality-adjusted life year for Western medicine, 4,477.09 RMB per quality-adjusted life year for Traditional Chinese Medicine, and 4,540.93 RMB per quality-adjusted life year for combined therapy. Relative to Traditional Chinese Medicine, the combined strategy required an additional 448 RMB and generated an extra 0.060 quality-adjusted life years.

The researchers determined that the discrete event simulation model was useful for evaluating the health economics of Traditional Chinese Medicine in chronic obstructive pulmonary disease. The simulated gain of 0.060 quality-adjusted life years equates to approximately 22 days in full health and falls within the reported minimum clinically important difference range of 0.03 to 0.07 quality-adjusted life years for the condition, suggesting perceptible group-level benefits. However, the authors emphasized caution due to individual-level variation, potential overfitting risks inherent in the single-trial model design, and the necessity of validating these exploratory findings in larger, geographically diverse multi-center studies.

Subject of Research: Health economic evaluation of combined therapy for chronic obstructive pulmonary disease

Article Title: Health economic evaluation of discrete event simulation model for treating chronic obstructive pulmonary disease based on traditional chinese medicine syndrome differentiation

Article References: Xie, Y., He, W., Wan, H., Zhou, R., Wang, J., & Li, J. (2026). Health economic evaluation of discrete event simulation model for treating chronic obstructive pulmonary disease based on traditional chinese medicine syndrome differentiation. Cost Effectiveness and Resource Allocation, 24(1), Article 136. https://doi.org/10.1186/s12962-026-00814-0

Image Credits: AI Generated

DOI: 10.1186/s12962-026-00814-0

Keywords: chronic obstructive pulmonary disease, discrete event simulation, health economics, cost-utility analysis, Traditional Chinese Medicine, Western medicine, quality-adjusted life years, incremental cost-utility ratio, Health, economic, evaluation, discrete