Abstract
The cost of T2D is on the rise. Emerging markets are facing even greater cost burden due to urbanisation and delays in diagnosis and treatment of T2D. The G15 Review is a systematic literature review (SLR) designed to explore T2D care in 15 countries of mixed healthcare structures. We report on the direct cost of T2D in emerging (EMG) vs established (EST) markets and the likely determinants of cost. The G15 Review comprised the following countries: Australia, Canada, France, Germany, Italy, Spain and UK (EST), and Brazil, China, Philippines, Russia, Saudi Arabia, Taiwan, Turkey and the United Arab Emirates (UAE) (EMG). A SLR of cost studies (2001-2018) was conducted in all 15 countries. EMBASE, MEDLINE, MEDLINE-IN-PROCESS and conferences were searched. Study eligibility was assessed independently by 2 researchers in 2 stages, using pre-defined criteria. Extracted data were converted into euros and analysed descriptively. 92 studies (41 EMG) were identified. No data could be ascertained for Australia, Russia, Philippines and UAE. Total annual direct costs (58/92) were reported as follows (EST): €4,880 (Canada); €2,003-€6,506 (France); €2,197-€5,146 (Germany); €1,279-€3,532 (Italy); €2,331-€3,432 (Spain); €2,882-€3,605 (UK). EMG showed a similar wide cost range: €396-€1,136 (Brazil); €719-€2,906 (China); €1,937 (Saudi Arabia); €1,388-€2,849 (Taiwan); €399-€466 (Turkey). Hospitalisations (n=17) and medications (n=20) represented (median) 42% and 35% of costs, respectively, and were comparable across markets. The presence of complications increased direct costs by 1.5 to 5 fold, mostly due to higher hospitalisations (up to 45% of costs). Additional cost drivers included glycaemic control, adherence, disease duration and socio-economic factors. The cost of T2D is determined by multiple clinical and socio-economic factors. Onset of complications adds substantially to cost. While direct cost of T2D may vary between countries, the distribution and determinants of cost follow the same pattern in both emerging and established markets.
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