Hospital burden of chronic obstructive pulmonary disease exacerbation in Hong Kong in the post COVID pandemic era: Impact of phenotype and exacerbation history

IntroductionChronic obstructive pulmonary disease (COPD) has been reported to have significant healthcare and economic burdens worldwide. Since the COVID-19 pandemic, there have been changes in the epidemiology of various chronic diseases. The healthcare and economic burden of severe acute exacerbation COPD (AECOPD) and the factors affecting the burden should be assessed in the post-pandemic era. MethodsA territory-wide study was conducted in Hong Kong to study the healthcare and economic burden of severe AECOPD from 2022 to 2024, and identify factors associated with an increase in the direct healthcare costs related to severe AECOPD. Adult patients with severe AECOPD admitted to the acute medical unit managed by the Hong Kong Hospital Authority from 2022 to 2024 were included. The primary outcome was the total headcount and admission numbers related to severe AECOPD, as well as the direct healthcare costs associated with severe AECOPD. The secondary outcomes included factors associated with increased direct healthcare costs resulting from severe AECOPD. ResultsFrom 2022 to 2024, there were 11,465 COPD patients admitted to acute medical hospitals for severe AECOPD, contributing to 25,053 hospital admissions and 150,717 bed days. The total direct healthcare cost was HKD $1.259 billion for these severe AECOPD. There was a significant increase in the severe AECOPD admission numbers over the 3 years. While the phenotype by baseline BEC did not affect the annual total healthcare costs related to severe AECOPD, patients with co-existing bronchiectasis had significantly higher annual number of severe AECOPD and annual direct healthcare costs. The annual number of severe AECOPD significantly correlates with total direct healthcare costs and annual direct healthcare costs related to severe AECOPD. ConclusionsSevere AECOPD carries a significant burden towards healthcare system. Patients with bronchiectasis and more frequent severe AECOPD were factors associated with a higher number of severe AECOPD episodes and the associated direct healthcare costs.