Global Economic and Social Burden of Chronic Obstructive Pulmonary Disease: A Systematic Review (2020-2024).

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and imposes a substantial economic and social burden on healthcare systems and society. Objective: To analyse recent evidence (2020-2024) on the economic and social burden of COPD, including direct, indirect, and intangible costs. Methods: A systematic review was conducted to synthesise recent evidence on the economic and social burden of COPD published between January 2020 and December 2024. Searches were performed in PubMed/MEDLINE, Scopus, and Web of Science. Original studies reporting direct healthcare costs, direct non-healthcare costs, indirect costs or intangible costs related to health-related quality of life (HRQoL) were included. Results: Thirty studies from 15 countries were included. Direct healthcare costs represent the main component of expenditure, largely driven by hospitalisations and exacerbations. Annual costs ranged from €3500 to €10,000 per patient in Europe and from US$10,000 to US$17,000 in the United States. Although absolute costs were lower in Asia, the relative financial burden on patients was considerable. Direct non-healthcare costs, including out-of-pocket expenses and long-term care, were particularly relevant in severe disease. Indirect costs related to productivity losses and unemployment were substantial and, in some middle-income countries, exceeded healthcare costs. Intangible costs included anxiety, depression, caregiver distress, impaired quality of life, and perceived financial toxicity, with high overall prevalence. Conclusion: COPD creates a considerable economic and social burden. Although direct costs are predominant, indirect, and intangible costs are decisive, particularly in contexts with lower healthcare coverage. Clinical factors (severity, exacerbations, and comorbidities) and socio-economic factors (educational level, income, and employment) explain much of the variability. A holistic approach that addresses health, social, and emotional dimensions is required for a more equitable and sustainable management.