title: Economic burden of chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  The aim of this study was to estimate the direct medical costs of COPD in two public health clusters in Singapore from 2005 to 2009.
  
  
  METHODS
  Patients aged 40 years and over, who had been diagnosed with COPD, were identified in a Chronic Disease Management Data-mart. Annual utilization of health services in inpatient, specialist outpatient, emergency department and primary care settings was extracted from the Chronic Disease Management Data-mart. Trends in attributable costs, proportions of costs and health-care utilization were analyzed across each level of care. A weighted attribution approach was used to allocate costs to each health-care utilization episode, depending on the relevance of co-morbidities.
  
  
  RESULTS
  The mean total cost was approximately $9.9 million per year. Inpatient admissions were the major cost driver, contributing an average of $7.2 million per year. The proportion of hospitalization costs declined from 75% in 2005 to 68% in 2009. Based on the 5-year average, attendances at primary care clinics, emergency department and specialist clinics contributed 3%, 5% and 17%, respectively, of overall COPD costs. On average, 42% of the total cost burden was incurred for the medical management of COPD. The share of cost incurred for the treatment of conditions related and unrelated to COPD were 29% and 26%, respectively, of the total average costs.
  
  
  CONCLUSIONS
  COPD is likely to represent a significant burden to the public health system in most countries. The findings are particularly relevant to understanding the allocation of health-care resources and informing appropriate cost containment strategies.
authors.affiliation: Health Services and Outcomes Research, National Healthcare Group, Singapore. kelvin_ws_teo@nhg.com
authors.forename: W-S Kelvin
authors.initials: WS
authors.lastname: Teo
authors.forename: Woan-Shin
authors.initials: WS
authors.lastname: Tan
authors.forename: Wai-Fung
authors.initials: WF
authors.lastname: Chong
authors.forename: John
authors.initials: J
authors.lastname: Abisheganaden
authors.forename: Yii-Jen
authors.initials: YJ
authors.lastname: Lew
authors.forename: Tow-Keang
authors.initials: TK
authors.lastname: Lim
authors.forename: Bee-Hoon
authors.initials: BH
authors.lastname: Heng
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000191:economics; D015897:Comorbidity; D004180:Direct Service Costs / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics*; D011634:Public Health / Q000191:economics; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000191:economics; D012846:Singapore / Q000453:epidemiology