Indirect Costs Of Diabetes Research Articles

906-P: Lost Workdays from Treating Type 2 Diabetes–Related Complications in Hong Kong: A Population-Based Cohort Study

To estimate the lost workdays associated with type 2 diabetes and related complications in Hong Kong in 2017 and inform productivity loss and indirect costs. Using population-representative data of 540,370 people with type 2 diabetes managed in the public sector, we fitted a negative binomial regression model to investigate the association of diabetes complications on length of stay. Model fit was assessed by Akaike information criterion. A total of 4.28 million workdays (mean 7.93, 95% CI 7.88-7.97) was lost in 2017. Table 1 shows the regression coefficients: interpreted as the expected log (length of stay) increase for each one-unit increase in the corresponding variable. For example, the adjusted length of stay for 60-year male without any complication is 6.82 days (95% CI 5.52-8.43) . Hemodialysis contributed to the longest length of stay, followed by renal failure, skin ulcer, amputation, heart failure, cerebrovascular disease, atrial fibrillation, neuropathy, peripheral vascular disease, cataract, myocardial infarction, retinopathy, and ischemic heart disease. Enrolment in the multidisciplinary Risk Assessment and Management Programme was associated with reduced length of stay. This lost workday analysis helps to inform the indirect costs of diabetes in terms of lost productivity, and is essential for estimating the total economic loss from diabetes. Disclosure H.Kwok: None. C.Ng: None. J.Quan: None. Funding Research Grants Council of the Hong Kong SAR, China [27112518].

Direct and Indirect Costs of Diabetes in Brazil in 2016.

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.

Economic costs of hospitalisation and length of stay in diabetes with coexisting hypertension with correlation to laboratory investigations: Where does India stand? A 5-year ground report.

The coexistence of diabetes mellitus (DM) and hypertension (HTN) worsens clinical outcomes and contributes to increased morbidity and mortality. This study aims to analyse the length of stay and healthcare costs by calculating the direct and indirect costs of diabetes with coexisting hypertension in North India. A prospective observational study was conducted atthe medicine department of the three different hospitals. The patients' mean age was (M=53.8, SD=11.5) years. Out of 1914 patients, 53.65% were female. Our study revealed that the median cost of medical supplies and equipment was 21.2 $. The median cost of dialysis was 47.5 $; the median cost of hospitalisation was 142.6 $. The treatment's median direct cost was 188.5 $, followed by the overall median cost of 295.6 $. The maximum overall cost of treatment was observed at 603.9 $. It was observed that maximum LOS was 14days for patients having BPS between 140 and 159mmHg and BPD between 110 and 119mmHg, and minimum LOS was found 3.5days. The present study highlighted that diabetes coexisting hypertension poses a high-economic burden on patients. This study explored that highly significant result for BPS, BPD, FBS and HbA1 c, whereas the significant results were obtained when RBS is compared with LOS and treatment costs. Our study concluded that mean difference of 9.24 $ in patients having FBS was 261-290mg/dL and >290mg/dL. The LOS is increased by 6.57days for patients with BPS between 140 and 159mmHg compared with BPS between 180 and 209 and above mmHg, which lowers treatment costs by -21.31$.

Direct non-medical and indirect costs of diabetes and its associated complications in Vietnam: an estimation using national health insurance claims from a cross-sectional survey

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...

Short-Term Trends in Economic Burden and Catastrophic Costs of Type 2 Diabetes Mellitus in Rural Southwest China.

Objectives This study is aimed at gaining insights on the changing prevalence, economic burden, and catastrophic costs of diabetes in rural southwest China. Materials and Methods Data were collected from two cross-sectional health interviews and examination surveys among individuals aged ≥ 35 years in rural Yunnan Province. A prevalence-based cost-of-illness method was used to estimate the cost of diabetes. Information about the participants' demographic characteristics and economic consequences of diabetes was obtained using a standard questionnaire. Fasting blood sugar levels were recorded for each study participant. Results During the study period, the overall prevalence of diabetes increased from 7.7% to 9.5% (P < 0.01) and the economic cost of diabetes increased 1.52-fold. The largest increases were observed in hospital costs (1.77-fold increase), while unit medication costs fell by 18.6%. Both in 2009 and in 2016, males had higher overall direct and indirect costs of diabetes than females (P < 0.05). Direct costs represented the largest component of economic cost of diabetes while hospital costs were the main drivers of direct medical expenditures, accounting for 66.2% of the total direct costs in 2009 and 75.9% in 2016. The incidence of household catastrophic health payment and household impoverishment due to diabetes was 24.0% and 17.9% in 2009 and 23.6% and 17.6% in 2016, respectively. These rates did not differ between the two survey years (P > 0.05). Conclusions The prevalence and economic burden of diabetes increased substantially from 2009 to 2016 in rural southwest China. The findings underscore an urgent need for the government to invest more financial resources in the prevention of diabetes and improvement of access to affordable medication in rural southwest China.

Economic Cost of Diabetes in Ampara District in Sri Lanka

Economic cost of diabetes comprises of two components, viz. the direct cost and indirect cost. Doctor consultation fees, transportation cost, cost of blood and urine tests, and cost of medication constitute the direct cost. Short term morbidity and permanent disability due to diabetes result in inability to work, which accounts for the indirect cost. The objective of the study was to measure the economic cost of diabetic patients in Sainthamaruthu Divisional Secretariat Area of Ampara district in Sri Lanka. The research area of this study was Sainthamaruthu Township in Ampara district, where the burden of diabetes is higher than in other places. This study used primary and secondary data, both qualitative and quantitative. Primary data was collected through a questionnaire. Sample was selected through the stratified sampling method from 243 patients. 100 questionnaires were distributed through the random sampling method. For the data analysis this study used cross-sectional descriptive method. The direct cost and indirect cost of diabetes was estimated by cost of illness method. Analysis was performed through SPSS and Excel. This survey found that the monthly average direct cost per patient in Sainthamaruthu Divisional Secretariat Area was US $19. A breakdown gives monthly average doctor consultation fees of US $5.15, monthly average transportation cost of US $1.12, monthly average cost for urine test US $0.47, monthly average cost for blood test US $1.32, and monthly average medication cost of US $10.93. To these must be added monthly average indirect cost of US $68.94. This is made up of US $49.20 lost per patient per month for permanent disability and US $19.74 lost per patient per month for short term morbidity. Therefore, the monthly average economic cost amounted to US $87.93 per patient. At the same time, a higher level of economic cost is borne by the male and lower cost borne by the income group that earned between US $175 and US $350. 54 percent of patients depend on their families to meet their diabetes related expenditure. So the major part of the cost of diabetes care is imposed on the families of diabetic patients in the study area. And it just proves to be a big economic burden on them.

An investigation into the prevalence of diabetes in the Northwest of Iran: The case study of Maragheh City

Background: Diabetes is a type of metabolic diseases whose common characteristic is the increase in blood sugar. The prevalence of diabetes worldwide has progressively reached epidemic proportions. Its complications are microvascular and macrovascular complications, gastrointestinal and genitourinary disorders, infection and glaucoma. This study was designed to examine the incidence of diabetes in case of gender and age differences, and to investigate its complications .to better understand related etiology.Materials and Methods: This research was a cross-sectional study undertaken on 380 diabetic patients referred to Amir-al-Momenin Hospital in Maragheh. The data were collected using patient records and analysed using SPSS software. The frequency and frequency percent of the qualitative data and the mean of the quantitative data were reported.Results: The analysis suggested that among 380 diabetic patients, 248 were female and 132 were male, and 95.3% of those surveyed were married. The mean age of the patients under investigation was 57.66. 303 patients (79.7%) of the participants had a history of drug use, and the drugs are mainly cardiovascular drugs (35.8%), metformin (33.9%), and glibenclamide (28.2%). Over 50% of the participants had a history of illness, particularly cardiovascular disease (48.2%), while the least number of the participant had seizures. The highest and lowest number of patients had the blood sugar range of 424-325 (84 patients, 22.1%) and the blood sugar range of 622-523 (17 patients, 4.5%) , respectively. Moreover, the largest number of subjects (65 patients, 17.1%) had the blood cholesterol in the range of 325-271. About 75 participants had too much LDL. Besides, no statistically significant relationship was found between diabetes and white blood cells . 172 subjects developed complications. 70 patients, 68 patients, 55 patients, 51 patients, 14 patients, 13 patients, and 5 patients had renal, gastrointestinal, cutaneous, respiratory, cardiovascular, ocular complications, and amputations, respectively. About 110 subjects had various habits such as special diet (n = 44), smoking (n = 39), addiction (n=26) and drinking (n=3). Among 11 subjects of gestational diabetes mellitus (GDM), most had a high body mass index (BMI), the protein in the urine of about 18 percent of the subjects was positive, and regarding glucose disposal in the urine, 53 subjects were +, 64 subjects were +, 42 subjects were +++, 1 subject was ++++. Seventy participants had ketone disposal, which indicates kidney disorder.Conclusion: The results revealed a higher prevalence of disease among middle-aged and older people in the society. The mean of B.M.I is 27.28 showing overweight in our population. The results also indicated a higher prevalence of hyperglycemia compared to hypoglycemia that may be due to very close relationship between diabetes and cardiovascular disorders, high levels of blood sugar in most of the diabetic patients. In addition, in a large number of fat people or people with hyperlipidemia were diabetic. In order to decrease mortality, and to diminish direct and indirect costs of diabetes, it is required to take essential measures. Such measures can include effective approaches to inform people for importance of nutrition education programs in controlling blood sugar and fat in diabetic patients via mass media and different programs.

Indirect costs of diabetes and its impact on the public finance: the case of Poland

ABSTRACTBackground: Growing public and private expenditure on healthcare results i.a. from the spreading of chronic diseases. Diabetes belongs to the most frequent ones, beyond neoplasms and cardiological diseases, and hence generates a significant burden for the public finance in terms of the direct costs. However, the economy suffers also from the indirect cost of diabetes that manifests itself in the loss in Gross Domestic Product (GDP) and general government revenues.Methods: This paper aims to measure this indirect cost, both in terms of GDP drop (social perspective) and public revenue drop (public finance perspective), in the case of Poland in 2012–2014. We use a modified human capital approach and unique dataset provided by the Social Security institution in Poland and the Polish Central Statistical Office.Results: Diabetes is a substantial and growing burden for the Polish economy. In the years 2012, 2013 and 2014 the indirect cost (output loss) amounted to 1.85 bn USD, 1.94 bn USD and 2.00 bn USD respectively.Conclusions: Estimated indirect cost of diabetes can be a useful input for health technology analyses of drugs or economic impact assessments of public health programmes.

Diabetes and Hypertension: A Position Statement by the American Diabetes Association.

Hypertension is common among patients with diabetes, with the prevalence depending on type and duration of diabetes, age, sex, race/ethnicity, BMI, history of glycemic control, and the presence of kidney disease, among other factors (1–3). Furthermore, hypertension is a strong risk factor for atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications. ASCVD—defined as acute coronary syndrome, myocardial infarction (MI), angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin—is the leading cause of morbidity and mortality for individuals with diabetes and is the largest contributor to the direct and indirect costs of diabetes. Numerous studies have shown that antihypertensive therapy reduces ASCVD events, heart failure, and microvascular complications in people with diabetes (4–8). Large benefits are seen when multiple risk factors are addressed simultaneously (9). There is evidence that ASCVD morbidity and mortality have decreased for people with diabetes since 1990 (10,11) likely due in large part to improvements in blood pressure control (12–14). This Position Statement is intended to update the assessment and treatment of hypertension among people with diabetes, including advances in care since the American Diabetes Association (ADA) last published a Position Statement on this topic in 2003 (3). #### Recommendations

The analysis of the cost and amputation rates of hospitalized diabetic foot infection patients

Direct and indirect costs of diabetes and its complications figure prominently in health care expenditure globally. The diabetic foot is one of the most common complications of diabetes and is usually associated with neurological and peripheral vascular problems, yielding foot ulcers and infection. The aim of this study was to analyze hospitalized diabetic foot patient costs and amputation rate changes over time. Hospitalized patients with infected diabetic foot ulcerations within a 4-year span, starting in January 2012, were retrospectively evaluated to analyze cost and amputation rate changes over time. One hundred thirty-eight diabetic patients were hospitalized and treated. Major amputation rates tended to increase; however, minor amputation rates tended to decrease over time. Mean cost per patient was $2880. The distribution of the costs according to the years was not significant. Treatment of infected diabetic foot ulceration is challenging and incurs high healthcare costs. Through intensive foot care and multidisciplinary team approaches, major amputation rates have gradually increased in recent years.

Excess cost burden of diabetes in Southern India: a clinic-based, comparative cost-of-illness study.

There are few data on excess direct and indirect costs of diabetes in India and limited data on rural costs of diabetes. We aimed to further explore these aspects of diabetes burdens using a clinic-based, comparative cost-of-illness study. Persons with diabetes (n=606) were recruited from government, private, and rural clinics and compared to persons without diabetes matched for age, sex, and socioeconomic status (n=356). We used interviewer-administered questionnaires to estimate direct costs (outpatient, inpatient, medication, laboratory, and procedures) and indirect costs [absence from (absenteeism) or low productivity at (presenteeism) work]. Excess costs were calculated as the difference between costs reported by persons with and without diabetes and compared across settings. Regression analyses were used to separately identify factors associated with total direct and indirect costs. Annual excess direct costs were highest amongst private clinic attendees (INR 19552, US$425) and lowest amongst government clinic attendees (INR 1204, US$26.17). Private clinic attendees had the lowest excess absenteeism (2.36 work days/year) and highest presenteeism (0.06 work days/year) due to diabetes. Government clinic attendees reported the highest absenteeism (7.48 work days/year) and lowest presenteeism (-0.31 work days/year). Ten additional years of diabetes duration was associated with 11% higher direct costs (p<0.001). Older age (p=0.02) and longer duration of diabetes (p<0.001) were associated with higher total lost work days. Excess health expenditures and lost productivity amongst individuals with diabetes are substantial and different across care settings. Innovative solutions are needed to cope with diabetes and its associated cost burdens in India.

Economic development and diabetes prevalence in MENA countries: Egypt and Saudi Arabia comparison.

Diabetes is increasing in epidemic proportions globally, exhibiting the most striking increase in third world countries with emerging economies. This phenomena is particularly evident in the Middle East and North Africa (MENA) region, which has the highest prevalence of diabetes in adults. The most concerning indirect cost of diabetes is the missed work by the adult population coupled with the economic burden of loss of productivity. The major drivers of this epidemic are the demographic changes with increased life expectancy and lifestyle changes due to rapid urbanization and industrialization. Our focus is to compare MENA region countries, particularly Egypt and Saudi Arabia, in terms of their economic development, labor force diversity and the prevalence of diabetes.

The direct and indirect cost of diabetes in Italy: a prevalence probabilistic approach.

Diabetes mellitus is a chronic degenerative disease associated with a high risk of chronic complications and comorbidities. However, very few data are available on the associated cost. The objective of this study is to identify the available information on the epidemiology of the disease and estimate the average annual cost incurred by the National Health Service and Society for the Treatment of Diabetes in Italy. A probabilistic prevalence cost of illness model was developed to calculate an aggregate measure of the economic burden associated with the disease, in terms of direct medical costs (drugs, hospitalizations, monitoring and adverse events) and indirect costs (absenteeism and early retirement). A systematic review of the literature was conducted to determine both the epidemiological and economic data. Furthermore, a one-way and probabilistic sensitivity analysis with 5,000 Monte Carlo simulations was performed to test the robustness of the results and define a 95% CI. The model estimated a prevalence of 2.6 million patients under drug therapies in Italy. The total economic burden of diabetic patients in Italy amounted to €20.3 billion/year (95% CI €18.61 to €22.29 billion), 54% of which are associated with indirect costs (95% CI €10.10 to €11.62 billion) and 46% with direct costs only (95% CI €8.11 to €11.06 billion). This is the first study conducted in Italy aimed at estimating the direct and indirect cost of diabetes with a probabilistic prevalence approach. As might be expected, the lack of information means that the real burden of diabetes is partly underestimated, especially with regard to indirect costs. However, this is a useful approach for policy makers to understand the economic implications of diabetes treatment in Italy.

Clinical and Cost Consequences of Metabolic Effects of Lurasidone Versus Other Atypical Antipsychotics in Schizophrenia

Objective: To estimate the economic burden of hyperglycemia and diabetes associated with lurasidone versus other atypical antipsychotics in schizophrenia. Methods: A discrete event simulation model was developed to conduct the analysis from both US payer and societal perspectives over a 3-year timeframe. The model, based on the values of metabolic parameters at 1 year of treatment, identified patients with hyperglycemia at that point and predicted incident cases of diabetes over 3 years using a risk equation from the Framingham Heart Study. Direct and indirect costs of diabetes and hyperglycemia were estimated, according to patients’ disease status over time. Data on metabolic changes at 1 year were mainly from 4 clinical studies of lurasidone, supplemented with published data for other atypical antipsychotics. Cost inputs (2012 US dollars) were obtained from published sources. Results: Compared with olanzapine, risperidone, and quetiapine XR, lurasidone was predicted to result in 2,785,351, and 847 fewer hyperglycemia cases and 1,142,153, and 67 fewer incident diabetes cases per 10,000 patients over 3 years, respectively. Consequently, there was a reduction in the economic burden of diabetes and hyperglycemia by approximately $23 million, $2.9 million, and $3.4 million from a US payer perspective, and $28 million, $3.6 million, and $3.7 million from a societal perspective. Conclusion: Adverse metabolic effects of atypical antipsychotics could have substantial unfavorable clinical and economic consequences. Lurasidone may reduce these burdens and may be a treatment alternative for patients with schizophrenia.

PDB51 - Direct and indirect cost of diabetes in italy: A prevalence probabilistic approach

PDB51 - Direct and indirect cost of diabetes in italy: A prevalence probabilistic approach

Direct and Indirect Cost of Diabetes in Italy: A Prevalence Probabilistic Approach

Direct and Indirect Cost of Diabetes in Italy: A Prevalence Probabilistic Approach

Indirect Cost Of Diabetes In The Arab Region

Diabetes is one of the chronic diseases with a high prevalence and consequently a substantial socio-economic burden in Arab countries. In this paper, we propose for the first time an estimation of the indirect economic cost of diabetes incurred by the loss of productivity caused by disability and premature mortality due to diabetes in the Arab region. The 21 countries were divided into three income groups and the indirect cost of diabetes was estimated in each group. The total indirect cost was estimated to be around USD 72 billion whereas the average per capita indirect cost was estimated to be USD 2770, varying from USD 423 in group 3 to USD 7959 in Group1. The huge indirect economic cost and the associated social burden stress the importance that health decision makers should give to sensitisation, early diagnosis and treatment of diabetes in the Arab region where the prevalence of diabetes is very high.

Health-care cost of diabetes in South India: A cost of illness study.

Objective:The objective of this study is to analyze the health-care cost by calculating the direct and indirect costs of diabetes with co-morbidities in south India.Methods:A prospective observational study was conducted at Rohini super specialty hospital (India). Patient data as well as cost details were collected from the patients for a period of 6 months. The study was approved by the hospital committee prior to the study. The diabetic patients of age >18 years, either gender were included in the study. The collected data was analyzed for the average cost incurred in treating the diabetic patients and was calculated based on the total amount spent by the patients to that of total number of patients.Findings:A total of 150 patients were enrolled during the study period. The average costs per diabetic patient with and without co-morbidities were found to be United States dollar (USD) 314.15 and USD 29.91, respectively. The average cost for those with diabetic complications was USD 125.01 for macrovascular complications, USD 90.43 for microvascular complications and USD 142.01 for other infections. Out of USD 314.15, the average total direct medical cost was USD 290.04, the average direct non-medical cost was USD 3.75 and the average total indirect cost was USD 20.34.Conclusion:Our study results revealed that more economic burden was found in male patients (USD 332.06), age group of 51-60 years (USD 353.55) and the patients bearing macrovascular complications (USD 142.01). This information can be a model for future studies of economic evaluations and outcomes research.

Smartphone-Based Glucose Monitors and Applications in the Management of Diabetes: An Overview of 10 Salient “Apps” and a Novel Smartphone-Connected Blood Glucose Monitor

A ccording to the American Diabetes Association, the direct and indirect costs of diabetes in the United States have exceeded $174 billion, and there are 25.8 million U.S. children and adults with diabetes.1 Numerous resources are available to help patients increase their role in the management of diabetes while simultaneously improving their metabolic parameters. Although the Internet is a burgeoning source of information and resources, the average patient often lacks the skills for finding and using the most optimal health care information.2 It is important for health care providers (HCPs) to educate patients about the available pragmatic technological resources for the management of their diabetes. Specifically, smartphones have become an integral component of daily life for many people in the United States. In 2011, > 85% of Americans owned and used a mobile phone, and half of those users also had Internet access with their mobile devices.3 The implementation of smartphone applications and tools for the management of diabetes may be an effective option in reducing the progression of diabetes and improving quality of life. Consistent self-monitoring blood glucose (SMBG) has been shown to be a useful tool in improving glycemic control in type 2 diabetes.4 The use of smartphone applications (“apps”) has already been shown to be a useful method for accurately logging and managing SMBG results. SMBG data that are logged on a smartphone app can be easily reviewed with HCPs to make recommendations about exercise, diet, or medications. A meta-analysis revealed that using SMBG data stored in and/or shared through a PDA (personal data assistant), logbook, the Internet, fax machines, and other innovative technologies, along with consistent feedback from an HCP, enhanced glycemic improvements and reduced hospitalizations.5 The goal of using smartphone apps is to effectively manage diabetes by improving glycemic control …

DIAMAP: a new way of working to develop a future research strategy

The epidemic of diabetes and the burden of mortality and morbidity from complications can only be tackled by research. The present investment in research is not sufficient for the exponential rise in the number of people with diabetes across Europe and the rising costs of treatment and care at such a time of economic uncertainty. It is known that the direct and indirect costs of diabetes far outstrip the investment in research in Europe. There are no real data available on how much is actually spent on research, although this information is easier to obtain from European sources (e.g. European Commission) than national sources. There is also no strategic research plan at the European level for diabetes research, although several member states do have such a plan. EURADIA developed the DIAMAP (road map for European diabetes research) project to attempt to address these issues with two large-scale surveys and a multi-national and multi-professional expert task force. DIAMAP is now coming to a close with the publication of a major report and presentations during the FEND and the EASD meetings. The future road map report has undergone a public consultation period and garnered feedback from across Europe. This article recounts the approach taken to the surveys, database development and structuring the research road maps to ensure that the patient was at the centre.