Healthcare Costs and Trends of Multimorbidity in COPD Patients: A Population-Based Study in Singapore
Year: 2026
Type: article
Study design: Observational Study
Abstract: Purpose: Chronic obstructive pulmonary disease (COPD) and its comorbidities impose substantial economic burdens on healthcare systems, but evidence remains scarce in Asian countries where patients exhibit distinct clinical and inflammatory phenotypes, as well as policy and health system differences. This study aimed to estimate direct medical costs of COPD multimorbidity, comparing to non-COPD patients in Singapore, and identify high-cost users. Patients and Methods: Using Singapore’s health administrative data (2012– 2019), we created a propensity score-matched COPD and non-COPD cohort and applied generalised linear models to estimate all-cause, index disease- and comorbidity-attributable costs. All costs were measured in patient-years (PYs) in 2023 Singaporean dollars (SGD$1=US$0.76=₤0.60=€ 0.69). Patient characteristics and comorbidity prevalence were compared across patients incurring top 10%, 11%– 50%, and bottom 50% of average annualised costs. Results: The study included 18,866 patients from each group (83% males, 17% females). Average annual direct medical costs were significantly higher among COPD patients ($5,290.9/PY; 95% confidence interval [CI]: 5,242.9– 5,350.1) than non-COPD patients ($1,110.4/PY; 95% CI: 1,085.9– 1,135.9). 33.8% of total costs were COPD-attributable, with major contributions from other respiratory (15.0%), circulatory (14.9%), metabolic (7.8%), and digestive (4.7%) diseases. From 2012 to 2019, hospitalisation costs declined (-$59.0/year), while primary care (polyclinic) costs increased sharply (+$148.8/year). Indian patients comprised 67% of the top 10 th cost percentile and experienced frequent hospitalisations (≥ 2/year). Conclusion: In Singapore’s multi-ethnic Asian context, COPD patients incurred substantial multimorbidity costs, particularly from respiratory, circulatory, and metabolic diseases, underscoring distinct Asian multimorbidity patterns and highlighting the need for integrated, multimorbidity-focused care models. Disproportionately high costs among Indian patients and low female prevalence warrant further investigation. Keywords: COPD, multimorbidity, comorbidities, economic burden, direct costs, health administrative data
Source: International Journal of COPD
DOI: 10.2147/copd.s563620
Institutions: National University of Singapore, Nanyang Technological University, Tan Tock Seng Hospital, National Healthcare Group, Singapore General Hospital, Kaohsiung Medical University, Kaohsiung Medical University Chung-Ho Memorial Hospital, Alexandra Hospital, National University Hospital, National University Health System, Changi General Hospital, University of Aberdeen, Observational & Pragmatic Research Institute, Optimum Patient Care, Ministry of Health
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,836
Funders: Pfizer, AstraZeneca, GlaxoSmithKline, Sanofi, Teva Pharmaceutical Industries, Chiesi Farmaceutici, CSL Behring, Regeneron Pharmaceuticals, INOVIO Pharmaceuticals, National Research Foundation, National Research Foundation Singapore, Singapore General Hospital, Ministry of Education, India, Shionogi, Imam Abdulrahman Bin Faisal University, Orient Europharma, National Science and Technology Council, Sanofi Genzyme, Medical Research Council, National Medical Research Council, Efficacy and Mechanism Evaluation Programme
Awards: G346305651, G3510775757
OpenAlex ID: W7129086384