Abstract
This study aimed to estimate current direct costs for managing type 2 diabetes mellitus (T2DM)-related complications including ischaemic heart diseases (IHD), myocardial infarction (MI), stroke, heart failure (HF), amputation, blindness, renal failure (RF) requiring haemodialysis (end-stage renal disease) and diabetic foot ulcer in the event year and subsequent year. Initially, diabetes-related complications are defined based on the Malaysian Clinical Practice Guidelines (CPGs) or published literatures while each resource unit was valued using local costing obtained from the public hospital or other sources. The interventions for the management of complications were supported by evidence in the Malaysian CPGs or local literature and confirmed by the physicians related to the field who are working at the public hospital. All costs were converted to the value of USD currency in the year 2016. On the whole, macrovascular diseases incurred the highest management cost with MI employing the highest management cost (USD4,528.37) in the event year, while the management of heart, failure disease incurs the highest management cost at USD524.79 for subsequent year management. End-stage renal disease was associated with the highest annual per-patient costs, with mean first year and subsequent year costs for haemodialysis estimated at USD9,905.37 and USD9,233.89. In studying the costs of managing of diabetes-related complications, these data are vital economic evaluation for diabetes interventions, particularly in managing complications to macrovascular and microvascular functions, as it contributes significantly to the economic burden in Malaysia’s public healthcare; hence significantly affecting the proportion of the overall healthcare costs.
Highlights
Over the years, the prevalence of type 2 diabetes mellitus (T2DM) has been on the rise in Malaysia (Hussein et al 2015)
It is believed that the risk factors for microvascular and macrovascular complications are markedly elevated for this group of patients and that diabetes complications are developing in this group (Harris and Eastman 2000)
The cost estimation in the present study indicates that managing diabetes complications is high
Summary
The prevalence of type 2 diabetes mellitus (T2DM) has been on the rise in Malaysia (Hussein et al 2015). The prevalence of diabetes in Malaysia was 15.2% in 2011 (Mustapha and Azmi 2013), and it has increased by 2.3% over four years (Tee and Yap 2017) This trend poses significant burden to healthcare payers because it requires billions of dollars in care annually to manage the disease itself, and to treat its macrovascular and microvascular complications. In Malaysia, RM1.4 billion (approximately USD0.33 billion [USD1:RM4.28]) is estimated to manage T2DM and its related complications in the public healthcare setting (Mustapha et al 2017). This expense excludes the cost of managing complications in undiagnosed T2DM patients. It is suspected that the total expenditure of managing diabetes complications is huge and possibly accounts for more than 50% of the total healthcare budget (Mustapha et al 2017)
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