Projected Rapid-Growing Economic Burden of Chronic Respiratory Multimorbidity in Singapore: Unveiling Diagnostic Gaps and Asian Phenotypes Through Health Administrative Data
Author(s)
Laura Huey Mien Lim, MSc1, Yah Ru Juang, BSc1, Mariko Siyue Koh, MBBS, MRCP2, Sanjay Haresh Chotirmall, MB, BCh, BAO, FRCPI, FCCP, FRCP, PhD3, Kelvin Bryan Tan, PhD4, John Abisheganaden, MBBS, MRCP, MMed, FAMS, FRCP3, Pei Yee Tiew, MD, PhD2, Mei Fong Liew, MBBS, MRCP, MMed5, Anthony Chau Ang Yii, MB, BChir, MA, MRCP6, Wenjia Chen, PhD1.
1Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, 2Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore, 3Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, 4Ministry of Health, Singapore, Singapore, 5Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hosp, Singapore, Singapore, 6Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore.
1Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, 2Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore, 3Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, 4Ministry of Health, Singapore, Singapore, 5Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hosp, Singapore, Singapore, 6Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore.
OBJECTIVES: Asthma and COPD are common chronic respiratory conditions linked to substantial comorbidity burdens. In Asia, their diagnostic overlap, under-diagnosis and unique multimorbidity patterns pose significant challenges. Our study aimed to estimate Singapore’s 20-year economic burdens of asthma-COPD-multimorbidity, offering comprehensive insights for the rapid aging Asian societies.
METHODS: First, we identified all residents with asthma and COPD from Singapore health administrative data (1998—2019), and estimated their annual rates of healthcare utilization (HCU) and per-episode costs (in 2023 Singapore dollar) from hospitalisations, emergency department (ED) visits and outpatient services (inclusive of medication dispensations), attributing into their primary diagnosis. Next, we applied change-point analysis to identify latest stable trends of HCU rates and per-episode costs, stratified by age-sex groups. Lastly, we developed a probabilistic simulation model with repeated sampling from bootstrapped distributions of parameters, and predicted 20-year multimorbidity cost burden of chronic respiratory patients.
RESULTS: In Singapore’s public health system, in 2024, asthma and COPD cases were respectively estimated at 93,258 (48% male, 52% female) and 10,324 (83% male, 17% female), representing 2.2% and 0.2% of residents, which will grow to 194,008 and 14,257 by 2043. The projected 20-year total costs of asthma population would be $15.3 (95% CI: $11.6-20.4) billion, 63% incurred by adult females, mainly attributable to asthma ($2.0 billion), oral corticosteroid-related adverse health events ($2.1 billion), other circulatory- ($2.0 billion), other metabolic- ($2.2 billion) and other respiratory diseases ($1.5 billion). Meanwhile, the projected 20-year total costs of COPD population would be $4.0 (95% CI: $2.2-5.8) billion, including 64.2% hospitalizations costs, 80% incurred by males, the most costly conditions were COPD ($0.7 billion), other respiratory- ($0.6 billion), circulatory-($0.4 billion), infectious- ($0.4 billion), and metabolic conditions ($0.4 billion).
CONCLUSIONS: The economic burden of asthma-COPD-multimorbidity in Singapore is significant and rapidly growing during 2024—2043, highlighting an urgent need for value-based, preventive, holistic care.
METHODS: First, we identified all residents with asthma and COPD from Singapore health administrative data (1998—2019), and estimated their annual rates of healthcare utilization (HCU) and per-episode costs (in 2023 Singapore dollar) from hospitalisations, emergency department (ED) visits and outpatient services (inclusive of medication dispensations), attributing into their primary diagnosis. Next, we applied change-point analysis to identify latest stable trends of HCU rates and per-episode costs, stratified by age-sex groups. Lastly, we developed a probabilistic simulation model with repeated sampling from bootstrapped distributions of parameters, and predicted 20-year multimorbidity cost burden of chronic respiratory patients.
RESULTS: In Singapore’s public health system, in 2024, asthma and COPD cases were respectively estimated at 93,258 (48% male, 52% female) and 10,324 (83% male, 17% female), representing 2.2% and 0.2% of residents, which will grow to 194,008 and 14,257 by 2043. The projected 20-year total costs of asthma population would be $15.3 (95% CI: $11.6-20.4) billion, 63% incurred by adult females, mainly attributable to asthma ($2.0 billion), oral corticosteroid-related adverse health events ($2.1 billion), other circulatory- ($2.0 billion), other metabolic- ($2.2 billion) and other respiratory diseases ($1.5 billion). Meanwhile, the projected 20-year total costs of COPD population would be $4.0 (95% CI: $2.2-5.8) billion, including 64.2% hospitalizations costs, 80% incurred by males, the most costly conditions were COPD ($0.7 billion), other respiratory- ($0.6 billion), circulatory-($0.4 billion), infectious- ($0.4 billion), and metabolic conditions ($0.4 billion).
CONCLUSIONS: The economic burden of asthma-COPD-multimorbidity in Singapore is significant and rapidly growing during 2024—2043, highlighting an urgent need for value-based, preventive, holistic care.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
MSR173
Topic
Economic Evaluation, Epidemiology & Public Health, Methodological & Statistical Research
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)