Twenty-year trends in excess costs of chronic obstructive pulmonary disease.

<bold>Rationale:</bold> Several major risk factors for chronic obstructive pulmonary disease (COPD), such as population aging, smoking rates, and air pollution levels are rapidly changing, causing inevitable changes in the population burden of COPD. We determined the excess direct costs of COPD and their trend from 2001 to 2020. <bold>Methods:</bold> Using administrative health data from British Columbia, Canada, we created a retrospective cohort of physician-diagnosed COPD patients based on a validated algorithm, matched with a non-COPD cohort on key demographic and socioeconomic factors. Excess direct medical costs (2020 Canadian$) were estimated using generalized linear models by analyzing hospital records, outpatient services, medications, and community-care billing. Comorbidity classes were classified using the International Classification of Diseases, 10th Revision. Excess COPD costs were determined as the adjusted difference in direct medical costs between COPD and non-COPD cohorts. <bold>Results:</bold> There were 208,554 and 404,703 individuals in the COPD and comparison cohorts, respectively (mean age at baseline, 69.1; 47.8% female). The excess costs of COPD were $5,828 [95% confidence interval (CI) 5,758–5,897] per patient-year (PY). Excess costs due to comorbidities were $3,588 (95% CI 3,554–3,622), with cardiovascular-related conditions alone exceeding the costs attributed to COPD ($1,375 vs $904). Excess costs increased by $219/PY, with higher increase in females than males ($222/PY vs $216/PY). <bold>Conclusions:</bold> Despite multifaceted initiatives in prevention and management, COPD-related economic burden, primarily from comorbid conditions, is rising. Escalating COPD costs and prevalence underscore the disease burden.