Lung disease can cost $165m a year

Hospital stays form bulk of costs to treat chronic patients, Singapore study finds

By Chang Ai-Lien, The Straits Times, 3 Jun 2012

Chronic lung disease in Singapore could be costing patients and health-care facilities US$128 million (S$165 million) a year, representing a significant burden to the public health system.

In the first local study on the economic cost of chronic obstructive pulmonary disease, or COPD, researchers have found that it costs the average patient US$2,000 each year to treat the ailment, more than three times that of asthma treatment. The bulk of the costs is due to hospital stays.

The researchers have called for more efforts to educate patients and health-care providers on the cost of the disease, and for its early detection and treatment.

COPD, which affects mainly smokers, is a slowly progressive disease of the airways characterised by a gradual loss of lung function. It is a serious health problem.

In 2010, COPD was the seventh principal cause of death in Singapore, claiming about 440 lives. It was also the seventh most common condition for hospitalisation, with more than 10,000 admissions that year.

The World Health Organisation predicts it will become the third leading cause of death worldwide by 2030.

'Based on earlier independent research that around 64,000 people here have COPD, the cost to the country works out to an estimated US$128 million a year,' said the study's lead researcher Kelvin Teo, research analyst at the health services and outcomes research unit at the National Healthcare Group (NHG).

'COPD represents a significant burden to Singapore's public health-care system, with hospitalisation costs being a major contributor,' said Mr Teo.

Such costs look set to rise as prevalence of the disease rises in tandem with the ageing population, he warned.

Between 1998 and 2009, COPD as a cause of death fell from 4.6 per cent to 2.4 per cent of all deaths. But, over the same period, the percentage of total hospitalisations due to the ailment rose from 1 per cent to 2 per cent.

COPD is a preventable disease and smoking is the main cause, Mr Teo noted. Smokers are unaware till the condition is at an advanced stage. Quitting smoking is the single most cost-effective way of cutting the risk of developing COPD and slowing its progression.

Studies have shown that regular and proactive primary care lowers the risk of hospitalisation in seniors with chronic respiratory diseases. So greater efforts should be considered to redistribute resources from current hospital-centric allocations to primary care settings such as GP clinics, Mr Teo suggested.

The study, by researchers from NHG and the National University Hospital, was published in the journal Respirology in January.

Associate Professor John Abisheganaden, senior consultant at the Respiratory and Critical Care Medicine Department at Tan Tock Seng Hospital, said the study would create more awareness about the disease, and the importance of preventing it.

'Primary facilities could screen patients with symptoms suggestive of COPD and manage them earlier, and offer smoking cessation to prevent deterioration and slow down the progression of the condition,' said Prof Abisheganaden, who was also involved in the research.

WHAT COPD IS

Chronic obstructive pulmonary disease (COPD) is an umbrella term for two main disorders: emphysema and chronic bronchitis, diseases characterised by the obstruction to air flow in and out of the lungs.

Common symptoms are breathlessness, excessive production of sputum and a chronic cough. It is not merely a 'smoker's cough', but an under-diagnosed, life-threatening lung disease. COPD is primarily caused by smoking, including passive smoking, and affects men and women almost equally.

It is not curable, but treatment can slow its progress. COPD can be diagnosed by a simple test to measure how deeply a person can breathe and how fast air moves in and out of the lungs.

TOP CAUSES OF DEATH IN S'PORE (2010)

Total number of deaths: 17,610

Percentage of total deaths

1. Cancer: 28.5 per cent

2. Ischaemic heart disease: 18.7 per cent

3. Pneumonia: 15.7 per cent

4. Cerebrovascular disease (including stroke): 8.4 per cent

5. Accidents, poisoning and violence: 5.5 per cent

6. Other heart diseases: 4.8 per cent

7. Chronic obstructive pulmonary disease: 2.5 per cent

8. Urinary tract infection: 2.5 per cent

9. Nephritis, Nephrotic syndrome and Nephrosis: 2.2 per cent

10. Diabetes mellitus: 1 per cent

Source: Ministry of Health