Development of an asthma policy model for Canada: Lifetime Exposures and Asthma outcomes Projection

Abstract

Objectives To address the need for health policy planning focused on early interventions for asthma, we developed the Lifetime Exposures and Asthma outcomes Projection (LEAP), a reference policy model for asthma in Canada. Methods Based on a previously developed concept map, we used an open-population microsimulation design to deal with the multidimensionality of risk factors and the need for modelling realistic aspects of adopting health technologies. The model consists of five intertwined modules: demographics, risk factors, asthma occurrence, asthma outcomes, and payoffs. The demographics module was based on sex- and age-specific estimates and projections from national surveys. For the first version of the model, we concentrated on key risk factors from the concept map: age, sex, family history of asthma at birth, and exposure to antibiotics in the first year of life. The distributions of risk factors were estimated from population-based administrative databases and a population-based longitudinal birth cohort. Quantitative evidence synthesis provided estimated parameters for the asthma occurrence and outcomes modules. Costs and utility weights were obtained from the literature. We conducted face validity, calibration, and internal validity assessments. Results LEAP is capable of modelling asthma-related health outcomes at the individual level from 2001 onwards. Age-sex stratified demographic projections from the model closely matched projections, while asthma prevalence and control levels matched their respective estimates from the administrative data and estimates from the literature. The LEAP model is publicly accessible as open-source software: https://github.com/tyhlee/LEAP.jl (Julia) and https://resplab.github.io/leap/ (Python). Conclusions LEAP is the first reference Canadian asthma policy model that emerged from identified needs for health policy planning for early interventions in asthma. It can provide a unified framework under which different interventions and policies can be consistently compared to identify those with the highest value proposition. The model needs to be gradually updated to accommodate other risk factors, and its validity should be independently examined.