{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T02:02:40Z","timestamp":1784426560399,"version":"3.55.0"},"reference-count":37,"publisher":"Innovative Healthcare Institute","issue":"3","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,19]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Chronic obstructive pulmonary disease (COPD) is a chronic, inflammatory, progressive respiratory disease characterized by chronic symptoms, such as cough, dyspnea, and expectoration, owing to persistent airway abnormalities that can lead to airflow limitations and inflammation, increasing the risk of exacerbations. Exacerbations are a characteristic feature of moderate and severe COPD, and they are considered a main cause of morbidity, mortality, and reduced quality of life. Patients with moderate to severe COPD are more susceptible to future exacerbations, which usually necessitate hospital admission and readmission, imposing a devastating burden on patients\u2019 quality of life and daily activities while posing an enormous burden on healthcare systems. This study aimed to assess the societal and economic burden of different COPD severity stages and their associated events among adult patients in Saudi Arabia over a 10-year period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A prevalence- and incidence-based cost-of-illness Markov model was constructed in Microsoft Excel 365 to estimate the direct medical and indirect costs incurred by patients with COPD in Saudi Arabia. The model projects the burden over 10 years. We developed a state-transition Markov model comprising five health states defined by exacerbation status. The five health states included: no exacerbations, one moderate exacerbation; two or more moderate exacerbations; one or more severe exacerbations; and death. Based on the ABE scheme classification in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, we mapped the health states accordingly; the no exacerbation state was considered equivalent to A\n                      <jats:sub>0<\/jats:sub>\n                      \/B\n                      <jats:sub>0<\/jats:sub>\n                      ; one moderate exacerbation corresponded to A1\/B1; and the E group was equally divided between patients experiencing two or more moderate exacerbations and those with one or more severe exacerbations. A 4-week cycle was used to capture changes in health states based on exacerbation status. Sensitivity analysis was conducted.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The total cost per patient per year was estimated at SAR 273,874 ($148,040 USD). The percent of work impairment among patients with moderate or severe exacerbations of COPD was the most impactful parameter that could increase costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>COPD imposes a substantial and growing burden on the Saudi economy, both in terms of direct and indirect medical costs. Our findings underscore the need to adopt policies that ensure comprehensive prevention and management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.36401\/jqsh-25-20","type":"journal-article","created":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T03:59:32Z","timestamp":1782532772000},"page":"50-59","source":"Crossref","is-referenced-by-count":0,"title":["The Societal and Economic Burden of COPD in Saudi Arabia"],"prefix":"10.36401","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2917-9388","authenticated-orcid":true,"given":"Gihan","family":"El-Sisi","sequence":"first","affiliation":[{"name":"HTA Office, Cairo, Egypt"},{"name":"Economics Section, American University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed","family":"AlSowayan","sequence":"additional","affiliation":[{"name":"Pulmonary Division, Internal Medicine Department, Security Forces hospital, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahya","family":"Habis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia"},{"name":"Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Alwakeel","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia"},{"name":"College of Medicine, Alfaisal University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussein","family":"Aljuwayed","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bader Jammah","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"King Saudi bin Abdulaziz for Health Science, National Guard Ministry, Jeddah, Saudi Arabia"},{"name":"King Abdulaziz Medical City, National Guard Ministry, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riyad","family":"Al-Lehebi","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh, Saudi Arabia"},{"name":"Pulmonary Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesreen","family":"Tayeb","sequence":"additional","affiliation":[{"name":"Pulmonology Department, King Fahd Armed Forces Hospitals, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousra","family":"Hamid","sequence":"additional","affiliation":[{"name":"HTA Office, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aljawharah","family":"Alkoraishi","sequence":"additional","affiliation":[{"name":"Pharmacy Department, King Saud University Medical City, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabila S.","family":"Ben Slimane","sequence":"additional","affiliation":[{"name":"Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maha","family":"Abushal","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Prince Sultan Military Hospital, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wedad","family":"Alnemari","sequence":"additional","affiliation":[{"name":"Sanofi, Greater Gulf Multi-Country Organization, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"22027","reference":[{"key":"i2589-9449-9-3-50-b01","series-title":"Am J Respir Crit Care Med","first-page":"1317","article-title":"Definition and nomenclature of chronic obstructive pulmonary disease: time for its revision","volume":"206","author":"Celli","year":"2022","unstructured":"Celli B,\nFabbri L,\nCriner G, et al. 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The economic burden of chronic obstructive pulmonary disease (COPD) in Europe: results from a systematic review of the literature. Eur J Health Econ. 2020;21:181\u2013194."},{"key":"i2589-9449-9-3-50-b34","series-title":"Int J Chron Obstruct Pulmon Dis","first-page":"275","article-title":"Economic burden of COPD in a Swedish cohort: the ARCTIC study","volume":"13","author":"Lisspers","year":"2018","unstructured":"Lisspers K,\nLarsson K,\nJohansson G, et al. Economic burden of COPD in a Swedish cohort: the ARCTIC study. Int J Chron Obstruct Pulmon Dis. 2018;13:275\u2013285."},{"key":"i2589-9449-9-3-50-b35","series-title":"Chest","first-page":"242","article-title":"Considerations for the correct diagnosis of COPD and its management with bronchodilators","volume":"154","author":"Anzueto","year":"2018","unstructured":"Anzueto A,\nMiravitlles M. Considerations for the correct diagnosis of COPD and its management with bronchodilators. Chest. 2018;154:242\u2013248."},{"key":"i2589-9449-9-3-50-b36","series-title":"Int J Chron Obstruct Pulmon Dis","first-page":"1303","article-title":"A systematic literature review of the humanistic burden of COPD","volume":"16","author":"Hurst","year":"2021","unstructured":"Hurst JR,\nSiddiqui MK,\nSingh B, et al. A systematic literature review of the humanistic burden of COPD. Int J Chron Obstruct Pulmon Dis. 2021;16:1303\u20131314."},{"key":"i2589-9449-9-3-50-b37","series-title":"Int J Chron Obstruct Pulmon Dis","first-page":"1033","article-title":"Patients with COPD\u2019 experiences, self-reported needs, and needs-driven strategies to cope with self-management","volume":"14","author":"Sigurgeirsdottir","year":"2019","unstructured":"Sigurgeirsdottir J,\nHalldorsdottir S,\nArnardottir RH, et al. Patients with COPD\u2019 experiences, self-reported needs, and needs-driven strategies to cope with self-management. 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