In Singaporeans with COPD, multiple comorbidities drive up healthcare costs

Patients with chronic obstructive pulmonary disorder (COPD) in Singapore have a substantial comorbidity burden that contributes to increased healthcare costs, according to new research.

In a large cohort of Singapore residents, annual direct medical costs between 2012 and 2019 were nearly five times higher among patients with COPD, averaging SGD 5,290.9 per person-year (PY) as opposed to SGD 1,110.4 per PY among non-COPD patients. [Int J Chron Obstruct Pulmon Dis 2026;doi:10.2147/COPD.S563620]

Hospitalization costs accounted for 70.1 percent of the total (SGD 3,703/PY), followed by primary care costs (including medications) at 20.4 percent (SGD 1,077.5/PY), emergency department costs at 7.7 percent (SGD 406.6/PY), and specialist care costs at 1.9 percent (SGD 99.8/PY).

In terms of conditions, COPD itself was the largest cost driver in the COPD group, contributing to 33.8 percent of the total (SGD 1,785.7/PY). This was followed by other respiratory conditions (15 percent, SGD 793.7/PY), circulatory diseases (14.9 percent, SGD 788.1/PY), metabolic disorders (7.8 percent, SGD 412.7/PY), digestive problems (4.7 percent, SGD 250.8/PY), neoplasms (3.7 percent, SGD 197.4/PY), and genitourinary diseases (3.6 percent, SGD 189.6/PY).

The costs across all mentioned disease categories in the COPD group were 2–6 times higher than those in the non-COPD group, which ranged from SGD 45.8 to 248.6/PY. Between 22 percent and 95 percent of costs across all comorbidity categories was attributed to hospitalizations.

The analysis included 18,866 COPD patients (mean age 68.7 years, 17 percent female, 80.4 percent Chinese) and 18,866 matched non-COPD patients. COPD patients had higher baseline prevalence of other respiratory, infectious, metabolic, and musculoskeletal diseases compared with non-COPD patients. The COPD group also had more frequent hospitalizations (2.2 vs 1.1), ED (2.5 vs 1.1), primary care (13.6 vs 4.6), specialist care visits (1.4 vs 1.1), and longer hospital bed-days (14.9 vs 8.3 days), but a lower annual median mortality rate (7.8 percent vs 14 percent).

Over the 8-year observation period, hospitalization costs declined at SGD 59/year, while primary care (polyclinic) costs increased sharply at 148.8/year. Indian patients made up 67 percent of the top 10th cost percentile and experienced frequent hospitalizations (≥2/year).

“From a health system perspective, our findings suggest that the observed profile of COPD care in Singapore—characterized by an older, predominantly male population, relatively low prevalence, and persistently high hospitalization costs—likely reflects late diagnosis and advanced disease at presentation, partially explaining the greater overall reliance on inpatient care over community-based alternatives like hospital-at-home services,” the authors explained.

Furthermore, the observed cost burden from respiratory, cardiovascular, and metabolic conditions points to Asian-specific COPD phenotypes and underscores the complexity of managing multimorbid patients, they added.

Altogether, these findings demonstrate why structured longitudinal follow-up, integrated multimorbidity care management, and early identification of patients at risk of high utilization and costs are needed, the authors said.

However, the authors acknowledged that transitioning from reactive, hospital-centred care toward preventive and predictive value-based care also require more sustainable payment reforms, including bundled or episode-based payments for multimorbidity care, risk-stratified capitation or shared-savings models for high-risk patients, and broader financing mechanisms to support digital monitoring and targeted interventions.

Ultimately, these changes will serve to improve outcomes and optimize resource use in this complex, multimorbid COPD population in Singapore, according to the authors.