Projection of Diabetes Population Size and Associated Economic Burden through 2030 in Iran: Evidence from Micro-Simulation Markov Model and Bayesian Meta-Analysis.

Mehdi Javanbakht,Atefeh Mashayekhi,Hamid R Baradaran,Aliakbar Haghdoost,Ashkan Afshin,Chen-Wei Pan

doi:10.1371/journal.pone.0132505

Abstract

BackgroundThe aim of this study was to estimate the economic burden of diabetes mellitus (DM) in Iran from 2009 to 2030.MethodsA Markov micro-simulation (MM) model was developed to predict the DM population size and associated economic burden. Age- and sex-specific prevalence and incidence of diagnosed and undiagnosed DM were derived from national health surveys. A systematic review was performed to identify the cost of diabetes in Iran and the mean annual direct and indirect costs of patients with DM were estimated using a random-effect Bayesian meta-analysis. Face, internal, cross and predictive validity of the MM model were assessed by consulting an expert group, performing sensitivity analysis (SA) and comparing model results with published literature and national survey reports. Sensitivity analysis was also performed to explore the effect of uncertainty in the model.ResultsWe estimated 3.78 million cases of DM (2.74 million diagnosed and 1.04 million undiagnosed) in Iran in 2009. This number is expected to rise to 9.24 million cases (6.73 million diagnosed and 2.50 million undiagnosed) by 2030. The mean annual direct and indirect costs of patients with DM in 2009 were US$ 556 (posterior standard deviation, 221) and US$ 689 (619), respectively. Total estimated annual cost of DM was $3.64 (2009 US$) billion (including US$1.71 billion direct and US$1.93 billion indirect costs) in 2009 and is predicted to increase to $9.0 (in 2009 US$) billion (including US$4.2 billion direct and US$4.8 billion indirect costs) by 2030.ConclusionsThe economic burden of DM in Iran is predicted to increase markedly in the coming decades. Identification and implementation of effective strategies to prevent and manage DM should be considered as a public health priority.

Highlights

Diabetes mellitus (DM) is among the leading causes of mortality worldwide, with an estimated at least 1.3 million deaths attributed to the illness in 2013 alone [1]
Identification and implementation of effective strategies to prevent and manage DM should be considered as a public health priority
Diabetes mellitus is a risk factor for other chronic health conditions, such as cardiovascular disease and complications resulting from it include nephropathy, amputations and blindness, all of which impose a burden to society by reducing quality of life, increasing the risk of premature death and raising the economic burden due to absenteeism in the labor market and increased health care costs [4,5,6,7,8,9,10]

Summary

Introduction

Diabetes mellitus (DM) is among the leading causes of mortality worldwide, with an estimated at least 1.3 million deaths attributed to the illness in 2013 alone [1]. In 2013, an estimated 382 million people lived with DM worldwide and current projections suggest this number will rise to 592 million by 2035 [2,3]. Iran is amongst the countries with the highest prevalence of DM in the region at 9.94% in the adult population [3]. Unlike most developed countries, where approximately half of reported cases are individuals older than 60 years, DM is most prevalent amongst the working population (20–59 years old), making it a major obstacle toward economic growth in Iran and other countries in the MENA region [13,14,15]. The aim of this study was to estimate the economic burden of diabetes mellitus (DM) in Iran from 2009 to 2030.

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