OBJECTIVES: To establish a set of proposals to improve the current approach to Chronic Obstructive Pulmonary Disease (COPD) within the Spanish National Health System (SNHS) and to estimate the impact its hypothetical implementation would generate from a clinical, healthcare, economic, and social perspective.

METHODS: A multidisciplinary group of 20 COPD experts (including healthcare professionals, patients, and informal caregivers) participated in a Delphi process, consisting of three rounds of online questionnaires, to agree on a set of 15 priority proposals to improve the current management of COPD within the SNHS in 4 areas: diagnosis, risk stratification, management of exacerbations, and management of stable COPD. Thereafter, a forecast-type social return on investment (SROI) analysis was carried out to estimate the tangible and intangible impacts of implementing these proposals within the SNHS over a one-year timeframe, in relation to the required investment. Financial proxies were used to estimate intangible impacts. A sensitivity analysis was performed to test the robustness of the model as a result of varying assumptions.

RESULTS: The implementation of the complete set of 15 improvement proposals would require a total investment of €668 million and have a social return of €2,079 million, associated with cost savings for the SNHS and improvements in the quality of life of patients and their informal caregivers, among others. Accordingly, every euro invested would yield a SROI ratio of €3.11 (€2.71 in the worst-case scenario and €3.62 in the best-case scenario) of both tangible (32.56%) and intangible nature (67.44%).

CONCLUSIONS: Implemented as a whole, this set of 15 proposals would yield an overall positive social impact. The results of this study may be used to develop policy and practice within the SNHS, such that interventions that may potentially improve current public health challenges associated with the management of COPD may be implemented.