Costs, outcomes, and avoidable services in hospitalized patients with acute exacerbations of COPD: a retrospective analysis from Shiraz, Iran

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) decreases lung function and quality of life and is the main driver of the costs of chronic obstructive pulmonary disease (COPD), the treatment of which in hospital is highly expensive. The present study aimed to evaluate tariff-based healthcare expenditures, treatment outcomes, and avoidable healthcare services among patients hospitalized with AECOPD at Shahid Faqihi Hospital in Shiraz, Iran, in 2024. This retrospective descriptive-analytical study evaluated tariff-based healthcare expenditures, treatment outcomes, and avoidable healthcare services among hospitalized patients with AECOPD. Data were collected using a researcher-developed data extraction checklist based on the study objectives and refined through consultation with clinical experts. The extracted data included patients’ demographic and clinical characteristics, treatment outcomes, tariff-based direct medical expenditures, and avoidable healthcare expenditures. Descriptive and inferential statistical analyses, including the independent samples t -test, one-way analysis of variance, and multiple linear regression, were performed. A one-way sensitivity analysis was conducted to assess the robustness of the estimated avoidable healthcare expenditures. Data were analyzed using SPSS version 23 and Microsoft Excel. The study included 150 patients, of whom 70.7% were male, and 81.3% had at least one comorbidity. Most patients (76%) experienced no more than two exacerbations per year. The mean tariff-based direct medical cost per patient was $2,620, while the mean avoidable healthcare expenditure was $754 per patient. ICU care accounted for the largest share of avoidable expenditure ($558), followed by hospitalization ($159), lung CT scans ($28), and antibiotics ($9). Most patients (80.6%) were discharged after recovery, 7.3% required ICU admission, and 10.7% died during hospitalization. Longer hospital stay, cerebrovascular disease, and the use of medications other than standard COPD therapies were independently associated with higher total medical costs. This study demonstrated that hospitalization for AECOPD is associated with a substantial tariff-based healthcare expenditure, with hospitalization, ICU care, and lung CT scans accounting for a considerable proportion of avoidable healthcare expenditures. Prolonged hospitalization, cerebrovascular disease, and the use of medications other than standard COPD therapies were identified as significant predictors of higher medical costs. These findings suggest that improving adherence to evidence-based clinical guidelines may help reduce avoidable healthcare services and support more efficient allocation of healthcare resources.