Background: COPD prevalence is rising. Although smoking rates were historically low in the Middle East, there is a rising burden of COPD based on air pollution, current smoking trends and population growth. Aims and objectives: We sought to use a mathematical model to estimate and project the future burden of COPD based on direct health care costs and indirect costs as well as the impact of exacerbation frequency. Methods: Using country-specific data, derived from publicly available datasets for 7 countries, an open cohort Markov model was developed to simulate population dynamics from 2019 to 2050. Population growth was modeled across different subgroups of age, sex, and smoking status. COPD costs were calibrated for these different subgroups, and distributions of COPD severity grades (using GOLD criteria) were modeled based on smoking status, household air pollution, PM2.5, and ozone. Direct healthcare costs, indirect absenteeism costs, and numbers of exacerbations associated with COPD were projected to 2050. Costs were adjusted for currency exchange rate and Consumer Price Index to match the US dollar in 2019. Results: See Table for modelling results. Conclusions: The future clinical and economical burden of COPD in the Middle East is likely to be substantial. Public health and advocacy efforts may be critical to prevent this anticipated major problem.

b = billion, m = million, PPPY = per patient per year