myCOPD App for Managing Chronic Obstructive Pulmonary Disease: A NICE Medical Technology Guidance for a Digital Health Technology

Abstract

myCOPD is a digital tool designed for people to manage their chronic obstructive pulmonary disease (COPD). It requires a device with an internet connection and incorporates tools for education, self-management, symptom tracking and pulmonary rehabilitation (PR). myCOPD was selected for medical technologies guidance by the UK National Institute for Health and Care Excellence (NICE) in 2020. The External Assessment Group (EAG) critiqued the company’s submission. The evidence comprised four clinical studies (three randomised controlled trials [RCTs] and one observational study) and real-world evidence from 22 documents. The RCTs had small sample sizes, limiting the power to detect statistically significant differences and to match patient characteristics across arms. The company produced two de novo models for two subgroups of people with COPD; people discharged from hospital with acute exacerbation of COPD (AECOPD) and people referred for PR. After the EAG updated input parameters and adjusted the model structures, cost savings of £86,297 per clinical commissioning group (CCG) compared with standard care were estimated for the AECOPD population, with myCOPD predicted to be cost saving in 74% of iterations. Cost savings of £22,779 per CCG were estimated for the PR population (with the assumption that the CCG had an existing myCOPD licence), with myCOPD predicted to be cost saving in 86% of the iterations. The Medical Technologies Advisory Committee concluded that although myCOPD has the potential to help manage COPD in adults, further evidence is required to address uncertainties in the current evidence base. NICE published this as Medical Technology Guidance 68 (National Institute for Health and Care Excellence (NICE). myCOPD for managing chronic obstructive pulmonary disease. 2022. Available at: https://www.nice.org.uk/guidance/mtg68/ ). Supplementary Information The online version contains supplementary material available at 10.1007/s40258-023-00811-x.

Use of Ecological Momentary Assessment to Measure Dyspnea in COPD

“… 53 An evaluation of four studies (three RCTs and one observational trial) using myCOPD identified potential cost savings in a subpopulation of AECOPD dependent upon myCOPD uptake and hospital readmissions. 45 Finally, EMA in COPD may provide more robust insight into the role of adherence (medication, pulmonary rehabilitation exercises, disease management strategies) on dyspnea. While it is crucial to consider monthly average adherence and its impact on disease control, EMA analysis provides a deeper understanding of the factors linked to an individual patient’s adherence behavior.…”

“…38,40 To show that it is feasible to utilize a mHealth platform for EMA measurement of COPD-related dyspnea in the home environment, a number of recent studies will be showcased in this section. 34,[41][42][43][44][45] An initial broad-based search on PubMed helped define the scope of the literature, and the subsequent search strategy was to search abstracts for the following terms: ("copd" OR "chronic obstructive pulmonary disease") AND ("EMA OR ecological momentary assessment") AND ("mHealth OR mobile health") to identify articles that reported on use of EMA via mHealth technology to measure dyspnea in patients with COPD. Studies were identified by team members through handsearching of databases and platforms including Scopus, Healthcare Administration, PubMed and databases from EBSCOHost Platform including MEDLINE, CINAHL Complete, APA PsycInfo, Health Source: Nursing/Academic Edition, Consumer Health Complete -EBSCOhost, Psychology and Behavioral Sciences Collection.…”

Developments in respiratory self-management interventions over the last two decades

“…88 A recent review of the current evidence regarding such an app, 'myCOPD', concluded that whereas the app is promising for self-managing COPD, the clinical benefit is still uncertain because of limitations in the evidence. 89 Knowing that education or self-monitoring as an isolated intervention have been proven to be ineffective, 29,31 providing apps that solely offer this should be used with extreme care. Whereas the use of digital technology may be a facilitator for some (e.g.…”