Health‐Care Burden of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Hong Kong in the Post‐COVID Pandemic Era—Impact of Phenotype and Exacerbation History

Rationale: Chronic obstructive pulmonary disease (COPD) is known to be associated with substantial health-care utilization and economic costs. Since the COVID-19 pandemic, the epidemiology of various diseases has undergone significant changes, it is important to evaluate the health-care impact and economic burden of acute exacerbations of COPD (AECOPD) in the post-pandemic period, along with factors influencing this burden, to inform effective management strategies and health-care planning. Objectives: To assess the health-care and economic burden of severe AECOPD from 2022 to 2024, and to identify factors associated with direct health-care costs. Methods: A territory-wide retrospective cohort study was conducted. Adult patients with AECOPD admitted to acute public hospitals in Hong Kong were included. The primary outcomes were the total number of AECOPD admissions and the associated direct health-care costs. Measurements and Main Results: From 2022 to 2024, a total of 11,465 patients were admitted to acute public hospitals for severe AECOPD, resulting in 25,053 hospitalization episodes and 150,717 bed days. The estimated direct health-care costs totaled 1.259 billion Hong Kong dollars (HKD). AECOPD admission numbers increased significantly over the 3 years. Patients with eosinophilic and non-eosinophilic phenotypes had similar annual direct health-care costs related to severe AECOPD. Patients with co-existing bronchiectasis had a significantly higher annual number of severe AECOPD episodes and direct health-care costs from severe AECOPD. Conclusions: Severe AECOPD imposes a substantial burden on the health-care system. The presence of bronchiectasis and a greater frequency of severe AECOPD episodes were identified as possible factors linked to increased direct health-care costs.