The Societal and Economic Burden of COPD in Saudi Arabia

Chronic obstructive pulmonary disease (COPD) is a chronic, inflammatory, progressive respiratory disease characterized by chronic symptoms, such as cough, dyspnea, and expectoration, owing to persistent airway abnormalities that can lead to airflow limitations and inflammation, increasing the risk of exacerbations. Exacerbations are a characteristic feature of moderate and severe COPD, and they are considered a main cause of morbidity, mortality, and reduced quality of life. Patients with moderate to severe COPD are more susceptible to future exacerbations, which usually necessitate hospital admission and readmission, imposing a devastating burden on patients' quality of life and daily activities while posing an enormous burden on healthcare systems. This study aimed to assess the societal and economic burden of different COPD severity stages and their associated events among adult patients in Saudi Arabia over a 10-year period.

A prevalence- and incidence-based cost-of-illness Markov model was constructed in Microsoft Excel 365 to estimate the direct medical and indirect costs incurred by patients with COPD in Saudi Arabia. The model projects the burden over 10 years. We developed a state-transition Markov model comprising five health states defined by exacerbation status. The five health states included: no exacerbations, one moderate exacerbation; two or more moderate exacerbations; one or more severe exacerbations; and death. Based on the ABE scheme classification in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, we mapped the health states accordingly; the no exacerbation state was considered equivalent to A₀/B₀; one moderate exacerbation corresponded to A1/B1; and the E group was equally divided between patients experiencing two or more moderate exacerbations and those with one or more severe exacerbations. A 4-week cycle was used to capture changes in health states based on exacerbation status. Sensitivity analysis was conducted.

The total cost per patient per year was estimated at SAR 273,874 ($148,040 USD). The percent of work impairment among patients with moderate or severe exacerbations of COPD was the most impactful parameter that could increase costs.

COPD imposes a substantial and growing burden on the Saudi economy, both in terms of direct and indirect medical costs. Our findings underscore the need to adopt policies that ensure comprehensive prevention and management strategies.