Presentation (CTI)

OBJECTIVES: To critically examine the scope and drivers of the economic burden of COPD in Indian adults over the last decade (2014-2024), including costs, cost-effectiveness, and healthcare resource use.
METHODS: A systematic review of English-language studies published from September 2014 to September 2024 was conducted in PubMed, following PRISMA 2020 guidelines.
RESULTS: From an initial pool of 4,152 records, only six studies (one RCT, two cross-sectional, two prospective observational, one economic evaluation) covering 735 unique patients met the inclusion criteria. Risk of bias was assessed using design-specific tools: the RCT was low risk (RoB-2), four observational studies were rated ‘fair’ on the Newcastle-Ottawa scale, and the cost-effectiveness study fulfilled 20 of 28 CHEERS 2022 criteria. Patients were predominantly male (80.2%); mean age ranged from 59.4 to 68.0 years, placing them in a working-age bracket. Reported COPD-induced absenteeism of 193.5 ± 33.6 hours over 28 days was associated with considerable economic implications. Direct medical costs were substantially higher in patients with comorbidities (INR 28,148) than those without (INR 13,460). Costs increased nearly eightfold with exacerbation severity, from INR 2,576 (moderate) to INR 19,883 (severe). Medication costs made up 72.5% of direct medical costs in one multicentre study. Hospitalization rates varied from 4.5% to 54.2%, with average stays between 4.8 and 7.4 days. Hospitalizations and medication costs were identified as major drivers of total COPD costs. A decision-tree analysis showed ward-based non-invasive ventilation to be cost-effective for respiratory failure in non-ICU hospital settings.
CONCLUSIONS: COPD imposes substantial direct and productivity costs in India, amplified by comorbidities and severe exacerbations, and driven by hospital care and medications. With only six studies in the decade, rigorous research is needed to guide cost-efficient management and policy.