Economic burden of diabetes: A population-prevalence based healthcare cost analysis

Background: Descriptive cost of illness study can provide an overall picture of diabetes in monetary terms in developing country, which may serve as a vital source of information for health care organizations and planning bodies to plan and prioritize local health policies and schemes. The aim was to explore cost description of diabetes in a tertiary care hospital in Anand district of Gujarat, India. Methods: This was an observational study with one year follow up. Ethical approval was taken from IEC. Patients were recruited and were divided into three categories according to duration of diabetes; newly diagnosed cases as category I, diabetes since last 5 year as category II and since last 10 years as category III. All these patients were followed up with 4 visits. Cost was calculated into three components; direct medical, direct non-medical and indirect cost. Descriptive and regression analysis was done using SPSS version 17.0. Results: Total 90 patients were analyzed after 12 patients were lost to follow up, 30 in each category. Mean total cost was found to be 12391.84 INR. Contributions from direct medical cost, direct non-medical cost and indirect cost were 74%, 2% and 24% respectively. Maximum cost incurred was due to medicine cost (44.14%) followed by complication cost (43.34%). Conclusions: Heavy economic burden highlights the urgent need for the health care organizations to plan and prioritize policies and accordingly in prevention and management of diabetes and its complications.

ObjectiveThe prevalence of diabetes in Vietnam has increased from 2.5% in 2007 to 5.5% in 2017, but the burden of direct non-medical and indirect costs is unknown. The objective of...

BackgroundIn 2000, the prevalence of diabetes among the 46 countries of the WHO African Region was estimated at 7.02 million people. Evidence from North America, Europe, Asia, Latin America and the Caribbean indicates that diabetes exerts a heavy health and economic burden on society. Unfortunately, there is a dearth of such evidence in the WHO African Region. The objective of this study was to estimate the economic burden associated with diabetes mellitus in the countries in the African Region.MethodsDrawing information from various secondary sources, this study used standard cost-of-illness methods to estimate: (a) the direct costs, i.e. those borne by the health systems and the families in directly addressing the problem; and (b) the indirect costs, i.e. the losses in productivity attributable to premature mortality, permanent disability and temporary disability caused by the disease. Prevalence estimates of diabetes for the year 2000 were used to calculate direct and indirect costs of diabetes mellitus. A discount rate of 3% was used to convert future earnings lost into their present values. The economic burden analysis was done for three groups of countries, i.e. 6 countries whose gross national income (GNI) per capita was greater than 8000 international dollars (i.e. in purchasing power parity), 6 countries with Int$2000–7999 and 33 countries with less than Int$2000. GNI for Zimbabwe was missing.ResultsThe 7.02 million cases of diabetes recorded by countries of the African Region in 2000 resulted in a total economic loss of Int$25.51 billion (PPP). Approximately 43.65%, 10.03% and 46.32% of that loss was incurred by groups 1, 2 and 3 countries, respectively. This translated into grand total economic loss of Int$11,431.6, Int$4,770.6 and Int$ 2,144.3 per diabetes case per year in the three groups respectively.ConclusionIn spite of data limitations, the estimates reported here show that diabetes imposes a substantial economic burden on countries of the WHO African Region. That heavy burden underscores the urgent need for increased investments in the prevention and management of diabetes.

To the Editor: Diabetes mellitus and its complications are a great economic challenge for any health system. Many countries have a growing worldwide diabetes mellitus problem. Projections from 2010 to 2030 estimate that diabetes mellitus in adults aged 65 and older will increase by 207% (from 27 million to 83 million cases) in developing countries and by 81% (from 26 million to 47 million cases) in developed countries.1 As a consequence, the global economic burden for diabetes mellitus and comorbid conditions is projected to increase dramatically from 2010 to 2030.2 In this context, using evidence from the Mexican case, the incremental trends of the economic burden of diabetes mellitus in older adults is highlighted. For older adults, in addition to the high costs of health services, the increasing demand for health services in future years complicates the challenges.3 Mexico, like the United States, faces problems with health financing that are generating high expenditures for all involved.4 This study involved evaluative research based on a longitudinal study of epidemiological and economic changes in the Mexican healthcare system caused by diabetes mellitus in older adults. The population base consisted of 4,032,189 older adults diagnosed with diabetes mellitus, as reported in the National Health Survey.5 Information on direct costs was obtained using the instrumentation technique. Indirect costs were determined using a human capital model developed for Latin America, based on premature mortality and temporary and permanent disability attributable to diabetes mellitus.6 To estimate the epidemiological changes for 2014 to 2018, a model was constructed according to the Box-Jenkins technique, 95% confidence intervals, and the Box-Pierce test (P < .001). For primary outcomes, 2015 was the cutoff. Table 1 shows the distribution of total costs. Direct costs represent 44% and indirect costs 56% of total costs. With respect to direct costs, the greatest effect comes from medicines, followed by outpatient services, and to a lesser degree, hospitalization. For the five main complications of diabetes mellitus, the greater effect is for nephropathy, followed by retinopathy, cardiovascular disease, neuropathy, and peripheral vascular disease. With regard to the relative weight of the economic burden according to origin of costs, the greatest economic burden was in out-of-pocket costs; for each $100 spent on diabetes mellitus in Mexico, $52 come out of pocket and $48 from the public health system. The indirect costs are distributed in three categories of estimation: premature mortality (5%), permanent disability (93%), and temporary disability (2%). Diabetes mellitus co-occurs with many other chronic conditions, more so in those aged 65 and older than in those who are younger (6.5 vs 2.9 conditions, respectively, in the United Kingdom).7 The results of the current study, like those from other countries, regarding comorbid conditions show that these add to costs of diabetes mellitus treatment. Governments of developing countries spend less per capita on diabetes mellitus, leaving substantial costs to be paid by other means. In this sense, older adult Mexicans with diabetes mellitus incur large out-of-pocket expenses. Even in the more-affluent United States, Medicare beneficiaries have an annual median out-of-pocket expense of $3,241 per person.8 There is an urgent need for diabetes mellitus prevention efforts worldwide. In Mexico, like in the United States, almost 50% of older adults have prediabetes mellitus. In the United States alone, each day since January 1, 2011, approximately 10,000 adults turned 65—an anticipated trend for the next 17 years.9 There is a need for intensified public health efforts by all countries addressing the unique national and individual burdens associated with diabetes mellitus management and prevention in older adults. This is a priority for the health system and for society. More resources need to be allocated to the design of new strategies to move from a treatment approach to one of prevention. In all countries, there is little or no intervention for the population with prediabetes mellitus.10 By shifting priorities, individuals’ catastrophic expenditures will decrease, and the high costs of temporary disability, permanent disability, and premature death that diabetes mellitus generates in older adults will diminish. New models and programs of care need to be implemented that can respond to the diverse health services that will be needed as a result of the epidemiological transition, particularly for diabetes mellitus and hypertension in older adults. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Arredondo, Aviles: acquisition of subjects and data, data analysis and interpretation, preparation of manuscript, review of manuscript. Arredondo: study concept and design. Sponsor's Role: None.

To estimate the total cost of diabetes mellitus in Sweden in 1994 and to compare the cost structure with a former Swedish study and with American studies. The study also aims to investigate how the total cost is distributed between control of and complications of the disease. In order to estimate the economic burden of diabetes mellitus in Sweden in 1994, the cost-of-illness method, based on the human capital theory, has been used. Both direct and indirect costs have been estimated using a prevalence approach and a 'top-down' method. The economic burden of diabetes mellitus is estimated at 5746 MSEK (1US$ = 7.50 SEK) in Sweden in 1994. The direct costs are estimated at 2455 MSEK and constitute about 43% of the total cost. The indirect costs (production loss due to morbidity and premature mortality) were the dominant costs and amounted to 3291 MSEK, or 57% of total cost. Comparisons with a previous Swedish study from 1978 show some interesting results. Firstly, the distribution of direct and indirect costs is identical between the two studies. Secondly, the distribution of costs between management/control of the disease and complications was about the same, comparing the situation 16 years apart. Four American studies show a cost structure similar to the cost structure presented in this study. The overall conclusion must be that very little has changed in the cost structure of diabetes in Sweden between 1978 and 1994.

Rotavirus is a major cause of gastroenteritis in children throughout Europe and the world. In addition to causing morbidity and mortality in children, rotavirus gastroenteritis (RVGE) creates a major economic burden on health care systems and families in Europe. The costs of hospital admissions for RVGE and nosocomial infections generate significant medical treatment costs throughout the region. Less information is available on the costs associated with less severe episodes and the costs borne by families, including lost time from work. The availability of rotavirus vaccines presents an effective opportunity to prevent RVGE and these associated economic costs, as well as providing protection to each child and hence benefiting the child's family. The adoption of rotavirus vaccine by health authorities in Europe will require a comparison of the costs and benefits. Economic evaluations that compare the costs of vaccination to the economic benefits of rotavirus vaccination will provide an estimate of its financial impact on health care systems and society. However, to provide a complete picture, economic evaluations of rotavirus vaccines will need to account for both the reduced costs and the reduced morbidity from prevented RVGE. Cost-effectiveness analyses based on quality-adjusted life years (QALYs) provide a systematic approach for assessing vaccination as a health investment, comparing the incremental costs associated with rotavirus vaccination and the reduced morbidity and mortality. QALYs provide a standardized approach for quantifying and comparing reductions in health-related quality of life and premature mortality. Although methodologic limitations exist in applying the QALY approach to childhood vaccines, their use in cost effectiveness analyses allows decision makers to consider the full health benefits of rotavirus and other vaccines.

Economic burden of influenza illness among children under 5 years in Suzhou, China: Report from the cost surveys during 2011/12 to 2016/17 influenza seasons

IntroductionStudies that estimate the economic burden of pediatric pneumococcal disease often only report direct medical costs and omit indirect non-medical costs. Given these indirect costs are not included in most calculations, the full economic burden attributable to pneumococcal conjugate vaccine (PCV) serotypes is often underestimated. This study seeks to quantify the full broader economic burden of pediatric pneumococcal disease associated with PCV serotypes.MethodsWe conducted a reanalysis of a previous study where non-medical costs associated with caregiving for a child with pneumococcal disease are considered. The annual indirect non-medical economic burden attributed to PCV serotypes was subsequently calculated for 13 countries. We included five countries with 10-valent (PCV10) national immunization programs (NIPs) (Austria, Finland, The Netherlands, New Zealand, and Sweden) and eight countries with 13-valent (PCV13) NIPs (Australia, Canada, France, Germany, Italy, South Korea, Spain, and the UK). Input parameters were derived from published literature. Indirect costs were inflated to 2021 values in US dollars (USD).ResultsThe total annual indirect economic burden associated with pediatric pneumococcal diseases attributable to PCV10, PCV13, the 15-valent (PCV15), and the 20-valent (PCV20) serotypes were $46.51 million, $158.95 million, $223.00 million, and $413.97 million, respectively. The five countries with PCV10 NIPs bear a greater societal burden associated with PCV13 serotypes, whereas the residual societal burden in the eight countries with PCV13 NIPs was primarily attributable to non-PCV13 serotypes.ConclusionThe inclusion of non-medical costs nearly tripled the total economic burden compared with only including direct medical costs estimated from a previous study. The results from this reanalysis can help inform decision-makers on the broader economic societal burden associated with PCV serotypes and the need for higher-valent PCVs.

Diabetes mellitus is one of the non-communicable diseases that depletes the wealth of any individual directly and indirectly due to the cost associated with treating the illness and its complications. The study aims to estimate the economic burden of Diabetes mellitus in Kenya from a societal perspective using a cost-of-illness approach. The study’s results and findings for the economic burden of diabetes mellitus in Kenya relied on the cost of illness approach. The approach identifies and measures all the costs of Diabetes mellitus, including direct and indirect costs. The 552,400 adult cases reported in 2019 resulted in a total economic cost of USD 372,184,585, equivalent to USD 674 per diabetes mellitus patient. The total direct costs accounted for the highest proportion of the overall costs at 61% (USD 227,980,126), whereas indirect costs accounted for 39% of the total economic costs (USD 144,204,459). Costs of medicines accounted for the highest costs over the total economic costs at about 29%, followed by the income lost while seeking care at 19.7%. Other costs that accounted for more than 10% of the total costs include productivity losses (19%), diagnostic tests (13%), and travel (12%). The rest of the cost categories accounted for less than 5%. Efforts should be made to reduce the costs of these medicines to enhance care. The high indirect costs reported, majorly in income lost by patients while seeking medical care, are 19%. Access to affordable health services such as diabetes mellitus education, regular blood glucose screening initiatives, and increasing local manufacturing of medicines can reduce the economic burden of diabetes mellitus and increase the health outcomes of the population and their contributions to society.

Background:The global economic burden of Diabetes mellitus (DM) is expected to reach US$ 745 billion in 2030. The growing prevalence of the disease, mainly type 2 diabetes, is the result of population aging, nutritional transition, which include growing rates of obesity and consumption of foods high in sugar and fat. Brazil is the fourth country in the number of patients with diabetes globally and follows the global trends, with a continuous increase in prevalence.Objectives:To estimate the economic burden of DM in Brazil, including all direct and indirect costs.Methods:We used a cost-of-illness approach to calculate the total economic burden of DM. We used official healthcare-related statistics referring to 2016.Findings:We estimated the Brazilian economic burden to reach US$ 2.15 billion in 2016, of which 70.6% are indirect costs related to premature deaths, absenteeism, and early retirement. We estimate that if the rate of growth of diabetes prevalence remains in Brazil, direct and indirect costs of diabetes will more than double by 2030 (an increase of 133.4% or 6.2% per year).Conclusion:Our results are in accordance with the literature that shows that indirect costs are more relevant in low- and middle-income countries due to poorer access to health care, which result in higher mortality rates from non-communicable diseases. However, due to the potentially underestimated prevalence of diabetes in Brazil and the lack of access to nationwide private healthcare costs, we estimate costs of diabetes in Brazil to be higher than the conservative results we found. The onset of the COVID-19 pandemic is likely to result in even greater costs than what we estimated.

Background: Diabetes mellitus represents a rapidly growing public health challenge in Pakistan, with urban populations experiencing particularly high prevalence rates. The economic burden on individuals, families, and healthcare systems remains inadequately quantified, limiting evidence-based policy formulation. To comprehensively assess the direct and indirect economic costs associated with diabetes mellitus among urban populations in Pakistan. Methods: A cross-sectional analysis was conducted across major healthcare facilities in Islamabad and Karachi involving 1,324 diagnosed diabetic patients recruited through systematic sampling. Direct costs included medical expenses (consultations, medications, laboratory tests, hospitalizations), while indirect costs encompassed productivity losses, transportation expenses, and caregiver time. Data collection utilized structured questionnaires, medical record reviews, and three-month cost diaries. Economic analysis was conducted from healthcare system and societal perspectives. Results: Mean annual direct medical costs were PKR 89,750 per patient in Islamabad and PKR 76,340 in Karachi. Total annual costs including indirect expenses reached PKR 156,890 and PKR 134,220 respectively. Medications constituted 43.2% of direct costs, followed by monitoring and consultations (28.7%). Catastrophic health expenditure affected 52.8% of families in Islamabad and 58.3% in Karachi. Type 2 diabetes patients with complications incurred 2.3 times higher costs than those without complications. Lower-income families spent proportionally more household income on diabetes management (18.4% vs. 7.2%). Conclusion: Diabetes mellitus imposes significant economic burden on urban Pakistani populations, with substantial costs disproportionately affecting lower-income families. High catastrophic health expenditure prevalence indicates inadequate financial protection mechanisms. Findings highlight urgent needs for comprehensive prevention programs, improved healthcare financing, and enhanced primary care services.

Breast cancer is the most common type of cancer among women in Turkey, with approximately 15.000 breast cancer diagnoses each year. In this study, our goal was to determine annual direct medical costs of all breast cancer patients in Turkey with top down cost approach. Data regarding patients who have been diagnosed with breast cancer and received health services from any hospital in Turkey in 2014 were used for the purpose of the study. Data were obtained from the MEDULA System for a total of 126.664 patient. Treatment of costs of patients were calculated based on types of patient admissions (inpatient/outpatient/intensive care) and costs of drugs and medical equipment. Indirect costs and out of pocket costs were not included. Total medical costs of 126,664 patients was calculated as $116.792.107,9, with an average treatment cost per patient of $922,1. Based on types of patient admission, intensive care treatment had the highest average cost with $2.916.5. In metastatic breast cancer patients, average annual treatment cost per patient is $2.326,6, which is 2.8 times higher compared to non-metastatic breast cancer patients. In order to ensure effective resource allocation at micro and macro level, healthcare administrators have to learn costs of diseases with high incidence such as breast cancer. Results obtained from studies on disease costs calculated using the top down cost approach provide data on actual health services use and therefore are seen as important tools for healthcare administrators in terms of effective resource allocation.

Diabetes is a significant public health problem resulting in substantial morbidity and mortality. The objectives of this study were 1) to determine the direct medical and indirect costs attributable to diabetes and 2) to calculate total and per capita expenditures of people with and without diabetes. Direct medical and indirect expenditures attributable to diabetes in 1997 were estimated at $98 billion. Medical expenditures for the treatment of diabetes were estimated for all individuals in the U.S. in 1997 by age-group, sex, race, type of condition, and site of service. Productivity costs due to disability and premature mortality were also estimated for selected patient cohorts. Etiological fractions based on national health care survey data and published literature were used to estimate the proportion of health service utilization and mortality associated with diabetes-related chronic complications and general medical conditions. Direct medical expenditures attributable to diabetes in 1997 totaled $44.1 billion and comprised $7.7 billion for diabetes and acute glycemic care, $11.8 billion due to the excess prevalence of related chronic complications, and $24.6 billion due to the excess prevalence of general medical conditions. The majority of attributable expenditures were for inpatient care (62%), followed by outpatient services (25%) and nursing home care (13%). Two-thirds of all medical costs for diabetes were borne by elderly people. Attributable indirect costs totaled $54.1 billion and comprised $17.0 billion resulting from premature mortality and $37.1 billion from disability. Total medical expenditures incurred by people with diabetes totaled $77.7 billion or $10,071 per capita, compared with $2,669 for people without diabetes. The economic burden of diabetes mellitus in the U.S. is enormous. Medical innovations that can delay the onset and slow the progression of diabetes have tremendous potential to mitigate the associated clinical and cost repercussions.

The burden of diabetes is complex and growing in epidemic proportions. According to the American Diabetes Association (ADA), ∼29.1 million Americans (9.3% of the population) were diagnosed with diabetes as of 2015, and >1 million new cases of diabetes are diagnosed in people ≥20 years of age in the United States each year (1). Diabetes is also on the rise globally. The International Diabetes Federation has predicted that the number of people with diabetes worldwide will rise from the present 415 million to 642 million in 2040 (2). Diabetes is the seventh leading cause of death in the United States and kills more people every year than AIDS and breast cancer combined (1). Patients with diabetes often have comorbid conditions of hypertension, dyslipidemia, retinopathy, neuropathy, kidney failure, lower limb amputations, and cardiovascular disease (3). Alarmingly, in the past decade, research has shown an increased risk for pancreatic, liver, colorectal, endometrial, and breast cancer among people living with diabetes (4). Although additional studies are needed to determine the causes of this risk, cancer screening is a necessary standard of diabetes care. Increased diabetes incidence in the United States is attributed to an aging population, increased diabetes risk among expanding minority groups (i.e., non-Hispanic blacks, Asians, Hawaiians/Pacific Islanders, and Native Americans/Alaska Natives), sedentary lifestyle, and high rates of obesity (5). In 2012, the ADA reported that diabetes accounted for $245 billion in public costs, including $176 billion in direct costs and $69 billion in indirect costs (i.e., disability, work loss, and premature mortality). In the absence of an improved diabetes management strategy, escalating costs will create an enormous economic burden for the already strained U.S. health care system. The prevalence of diabetes is 17% higher in adults living in rural areas than in the population as a whole (6). Rural populations …

To investigate the magnitude and characteristics of the economic burden resulting from acute pesticide poisoning (APP) in South Korea. The total costs of APP from a societal perspective were estimated by summing the direct medical and non-medical costs together with the indirect costs. Direct medical costs for patients assigned a disease code of pesticide poisoning were extracted from the Korean National Health Insurance Reimbursement Data. Direct non-medical costs were estimated using the average transportation and caregiving costs from the Korea Health Panel Survey. Indirect costs, incurred by pre-mature deaths and work loss, were obtained using 2009 Life Tables for Korea and other relevant literature. In 2009, a total of 11,453 patients were treated for APP and 1311 died, corresponding to an incidence of 23.1 per 100,000 population and a mortality rate of 2.6 per 100,000 population in South Korea. The total costs of APP were estimated at approximately US$ 150 million, 0.3% of the costs of total diseases. Costs due to pre-mature mortality accounted for 90.6% of the total costs, whereas the contribution of direct medical costs was relatively small. Costs from APP demonstrate a unique characteristic of a large proportion of the indirect costs originating from pre-mature mortality. This finding suggests policy implications for restrictions on lethal pesticides and safe storage to reduce fatality and cost due to APP.