In Singapore, COPD ranks among the top 10 causes of mortality.A population-based study of individuals with chronic obstructive pulmonary disease (COPD) in Singapore shows substantial and rising healthcare costs.
“In Singapore’s multiethnic 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,” the investigators said.
Over 8 years, the average annual direct medical costs were nearly fivefold higher among COPD vs non-COPD patients ($5,290.9/person-year [PY] vs $1,110.5/PY). [Int J Chron Obstruct Pulmon Dis 2026:21:563620]
Hospitalization accounted for 70.1 percent of the cost, followed by primary care (including medications), emergency department, and specialist care (20.4, 7.7, and 1.9 percent, respectively).
“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 reflected 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 researchers explained.
The rising outpatient costs may reflect the introduction of newer and more advanced pharmacological therapies, including triple therapy and long-acting bronchodilators, and the gradual strengthening of outpatient management, they added. “[However,] specialist care utilization remained low, [suggesting] further scope to shift care from inpatient to ambulatory settings.”
In COPD patients, COPD itself was the top contributor to the total cost (33.8 percent), followed by other respiratory (15 percent), circulatory (14.9 percent), and metabolic conditions (7.8 percent), which were all higher than in non-COPD patients. Hospitalizations comprised 22–95 percent of costs across all comorbidity categories.
Value-based care approaches
In Singapore, COPD ranks among the top 10 causes of mortality, yet the last economic burden study was conducted over a decade ago. This reported increasing per-patient costs from 2005 to 2009, but the study did not evaluate comorbidity-attributable costs. [https://www.moh.gov.sg/others/resources-and-statistics/principal-causes-of-death, accessed 18 September 2026; Respirology 2012;17:120-126]
Using Singapore’s health administrative data (2012–2019), the researchers created a propensity score-matched COPD and non-COPD cohort. Each group included 18,866 patients (mean age 68.7 years, 83.9 percent men, 81.6 percent Chinese). Costs were measured in 2023 Singapore dollars.
Of note was the underrepresentation of women in the study, which may reflect underdiagnosis and distinct Asian phenotypes. This aligned with evidence from Japan and South Korea, where diagnosis frequently hinges on smoking history. [Respirology 2004;9:458-465; Am J Respir Crit Care Med 2005;172:842-847; JAMA 2016;315:1378-1393] This may have overlooked non–smoking-related COPD in women. Women frequently experience worse symptoms and higher mortality despite lower smoking rates, hence the need for targeted research, the researchers said.
They also acknowledged certain limitations, including missing spirometry and private-sector data. Nonetheless, the results support the adoption of value-based care approaches in Singapore, including structured longitudinal follow-up, integrated multimorbidity care management, and early identification of patients at risk of high utilization and costs, as well as the development of more sustainable, flexible, and comprehensive payment models.
“By leveraging comprehensive records from 4.1 million Singapore residents … our study provides robust, granular multimorbidity-related cost estimates compared to prior Asian studies that relied on modelling, surveys, or cross-sectional data, which are limited by recall bias and parameter uncertainty,” the researchers said.
The higher all-cause medical costs in the COPD group highlight the significant system-level COPD burden and the need for earlier detection and proactive chronic disease management, they added.
“The insights generated may also inform policy and clinical practice in other Asian health systems facing comparable COPD care burdens and undergoing similar primary care and health system reforms,” they concluded.