Projecting the 20-year healthcare resource burden of asthma and COPD multimorbidity: insights from Singapore for integrated chronic respiratory care in South-East Asia

Background Asthma and chronic obstructive pulmonary disease (COPD) incur significant comorbidity and healthcare burden. However, their future economic burden remain unclear. Objective To project 20-year (2024-2043) asthma and COPD multimorbidity costs in Singapore, illustrating broader Southeast Asian trends. Methods Patients with asthma (all ages) or COPD ( ≥ ≥ 40 years) were identified from Singapore’s health administrative data (2002–2019). Age- and sex-specific, disease-specific per-episode costs and annual healthcare utilisation rates (hospitalisation, emergency department, and outpatient) were estimated using generalised linear models and projected using change-point analysis. Population-level costs were projected using a probabilistic simulation model incorporating population forecasts. Costs were reported in 2023 Singaporean dollars (SGD$1 = US$0.76 = ₤0.60 = €0.69). Results Asthma cases are projected to triple from 64,338 in 2019 to 192,409 by 2043 (95% confidence interval [CI]: 165,493–225,141), incurring $7.8 billion (95% CI: 4.4–17.1) from 2024–2043. Apart from asthma (16.4%), costs are driven by metabolic (20.0%), circulatory (14.3%), and other respiratory (9.2%) diseases, with children bearing the highest burden (girls: 39.9%; boys: 22.6%). COPD cases would grow from 8,988 in 2019 to 11,038 (95% CI: 8395–13,326) in 2043, incurring $2.4 billion (95% CI: 1.6–4.5) from 2024–2043. Apart from COPD (20.3%), metabolic (17.4%), circulatory (17.0%), and other respiratory diseases (9.8%) are the largest cost components, with elderly and adult males bearing the highest burdens (47.8% and 40.1%). In both cohorts, 20-year projected costs are dominated by outpatient (55%) and hospitalisation costs (30–40%). Conclusion The 20-year multimorbidity costs of asthma and COPD are significant, especially in cardiometabolic comorbidities, underscoring the need for holistic, value-based care.