Aim: This study aimed to estimate direct health cost (DHC) associated with COPD in Morocco and identify its determinants.

Methods: A cost of illness, prevalence based study among COPD patients was carried out in university hospital of Fez in 2021-2022. Data were collected using an anonymous questionnaire including socio-demographic, clinical data and health care resources utilization: days in hospital, medical visits, tests performed and drugs. Patients were classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Costs were estimated using bottom up approach by multiplying the use of resources in terms of number by the official prices published by the national agency for health insurance. Costs were calculated from societal perspective with 12 months? time horizon.

Results: We included 159 patients. The mean age was 68.7±9.7 years, 82.4% were men and 80.4% were current or former smokers. More than tree quarts (78.7 %) were at ?high-risk? groups (grades C?D). The average DHC was $1816.6±1582.7. Pharmaceutical and hospitalizations costs represented the highest part of DHC (42.5% and 22.1%respectively). DHC increased with increasing disease severity, it was higher among patient classified (stages C-D) compared to those classified (A-B) ($2080.6±1618.6vs $791.7±522.8, p<0.001). The cost was approximately threefold higher among patients with ?1 per year severe exacerbations ($2983.4±1812.8 vs $1009.8± 620.3). (p<0.001). Current and former smokers were costly to the healthcare system than nonsmokers (p=0.029).

Conclusion: High cost of management of COPD imply more strengthening tobacco control measures.