Integrating Disease Burden and Cost-Effectiveness for Value-Based Prioritisation of COPD Interventions: A Narrative Review.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and healthcare expenditure worldwide. Disease burden and economic value are typically evaluated separately, limiting integrated assessment for value-based healthcare and resource allocation. This review integrated COPD burden-reduction potential with the incremental cost-effectiveness ratio (ICER) to prioritise interventions by health impact and economic value. Methods: This narrative review was conducted with reference to the Scale for the Assessment of Narrative Review Articles (SANRA). PubMed, Embase, and the Cochrane Library were searched from inception to August 2026 for evidence on COPD burden, healthcare costs, and intervention economic outcomes. Reporting completeness and methodological quality were assessed using CHEERS 2022, the CHEC-list, and AMSTAR 2, as appropriate. Interventions were synthesised within an integrated disability-adjusted life years (DALYs)-ICER framework. Results: Eighty publications contributed to the synthesis. Acute exacerbations, pulmonary complications, and major comorbidities were the principal drivers of COPD burden and healthcare costs. Smoking cessation and pulmonary rehabilitation showed the most favourable combination of burden-reduction and economic value. Influenza and pneumococcal vaccination showed favourable profiles, although their classification remains provisional because COPD-specific economic evidence is limited. Triple inhaled therapy showed context-dependent economic value across healthcare settings, while long-term azithromycin and long-term oxygen therapy combined with home mechanical ventilation were economically favourable primarily in selected high-risk populations. Ensifentrine and mepolizumab in type 2 COPD demonstrated clinically meaningful benefits but less favourable economic value at the prices evaluated in their source settings. ICS-containing therapy in low-eosinophil, non-exacerbating patients, household air pollution control, and comorbidity-directed interventions could not be formally classified because applicable COPD-specific economic evidence was insufficient. Conclusion: Integrating burden-reduction potential with ICER-based cost-effectiveness provides a conceptual framework for prioritising COPD interventions by health impact and economic value, while highlighting priorities for COPD-specific economic evaluation and future validation.