Abstract
Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries. Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE) study (mean age at entry 66 y). The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies) using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$), which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions) and lowest for nephropathy (15%-26%). The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across region) and heart failure (16-31 d) and lowest for nephropathy (12-23 d). Considering regional differences, probabilities of hospitalization were lowest in Asia and highest in Established Market Economies; on the other hand, lengths of stay were highest in Asia and lowest in Established Market Economies. Overall estimated annual hospital costs for patients with none of the specified events or event histories ranged from Int$76 in Asia to Int$296 in Established Market Economies. All complications included in this analysis led to significant increases in hospital costs; coronary events, cerebrovascular events, and heart failure were the most costly, at more than Int$1,800, Int$3,000, and Int$4,000 in Asia, Eastern Europe, and Established Market Economies, respectively. Major complications of diabetes significantly increase hospital use and costs across various settings and are likely to impose a high economic burden on health care systems.
Highlights
The prevalence of diabetes worldwide was estimated to be 2.8% in 2000 and projected to rise to 4.4% by 2030, with more than three-quarters of people with diabetes living in developing countries [1]
Such an approach provides estimates of the overall resources devoted to the treatment of diabetes, it provides no indication of how different types of complications contribute to health care costs
The purpose of this study was to estimate acute and long-term resource use associated with five major complications of diabetes, on the basis of patient-level information from the Action in Diabetes and Vascular Disease (ADVANCE) study [10], a multinational clinical trial that included over 11,000 participants from 20 countries
Summary
The prevalence of diabetes worldwide was estimated to be 2.8% in 2000 and projected to rise to 4.4% by 2030, with more than three-quarters of people with diabetes living in developing countries [1]. Lacking microlevel data, a recent estimate of the global health care costs of treating diabetes was based on country-level information regarding total health care spending, the prevalence of diabetes, and ratios of the costs of care for people with and without diabetes [9]. Major longterm complications of diabetes include kidney failure and an increased risk of cardiovascular problems such as heart attacks, heart failure, stroke, and problems with the blood vessels in the arms and legs Because of these complications, the life expectancy of people with diabetes is about ten years shorter than that of people without diabetes
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