OBJECTIVES: Given the large population size and the high chronic obstructive pulmonary disease (COPD) prevalence in China, our aim was to project the current and expected future economic and health burden of COPD in China over the next 20 years from 2020 to 2039.

METHODS: We created a probabilistic decision-analytic model of COPD for the Chinese population aged ≥40 years. Data on projections of the population growth and urbanization rates were obtained from the United Nations Population Division. Smoking rates, COPD prevalence, severity distribution, COPD-related costs and utility inputs were obtained from the most recent published literature. We modeled direct medical costs, indirect costs, and loss of quality-adjusted life years (QALYs) from a societal perspective. In subgroup analyses, we modeled projected costs and QALYs lost for each sex, age, urban/rural residence, and smoking status subgroup.

RESULTS: The total undiscounted COPD-related direct and indirect costs (in 2020 US dollars) and losses of QALYs were projected to be $5,142 billion and 1,493 million, respectively, from 2020 to 2039. The corresponding discounted (at 5%) estimates were $3,296 billion USD and 962 million QALYs lost. The discounted costs were mainly driven by direct medical costs ($2,820 billion) with lower contributions from direct non-medical ($146 billion) and indirect costs ($351 billion). The discounted costs for hospitalizations were estimated to be $2,061 billion, accounting for 73% of the total projected direct costs and 63% of the total projected economic burden. 50- to 59-year-old males who are current smokers and live in urban areas are expected to incur the greatest economic and health COPD burden amongst all subgroups.

CONCLUSIONS: COPD is projected to impose a substantial economic and health burden in China over the next 20 years. Policies to alleviate smoking rates and treatments reducing COPD-related hospitalizations have the highest potential to reduce the overall COPD burden.