The worst thing about diabetes is the cost of managing the disease. Because of its chronic nature, the severity of its complications and the means required to control them, diabetes is a costly disease, not only for the affected individual and his/her family, but also for the health authorities.
The financial burden borne by people with diabetes and their families as a result of their disease depends on their economic status and the social insurance policies of their countries. In the poorest countries, people with diabetes and their families bear almost the whole cost of the medical care they can afford.
Studies in India estimate that, for a low-income Indian family with an adult with diabetes, as much as 25% of family income may be devoted to diabetes care. For families in the USA with a child who has diabetes, the corresponding figure is 10%.
In WHO’s Western Pacific region a recent analysis of health care expenditure has shown that 16% of hospital expenditure was on people with diabetes. In the Republic of the Marshall Islands this figure was 25%. 20% of “offshore expenditure” on health by Fiji was on diabetes related complications ‒ instances where facilities for care were not available in Fiji, so patients had to travel elsewhere. These represent considerable sums for countries that can ill afford such massive expenditure on preventable conditions.
Direct costs to individuals and their families include medical care, drugs, insulin and other supplies. Patients may also have to bear other personal costs, such as increased payments for health, life and automobile insurance. (We will not even discuss self-monitoring equipment, insulin pumps, and other high-tech gadgetry that’s beyond the reach of the average diabetic)
Put in perspective, this means in Latin America families pay 40-60% of medical care expenditures from their own pockets. In Mozambique, diabetes care for one person requires 75% of the per capita income; in Mali it amounts to 61%; Vietnam is 51% and Zambia 21%.
Expressed in International Dollars (ID), which correct for differences in purchasing power, estimated global expenditures on diabetes will be at least ID 418 billion in 2010, and at least ID 561 billion in 2030. An estimated average of ID 878 per person will be spent on diabetes in 2010 globally.
The World Health Organization (WHO) has predicted net losses in national income from diabetes and cardiovascular disease of ID 557.7 billion in China, ID 303.2 billion in the Russian Federation, ID 336.6 billion in India, ID 49.2 billion in Brazil and ID 2.5 billion in Tanzania (2005 ID), between 2005 and 2015.
Direct costs to the healthcare sector include hospital services, physician services, lab tests and the daily management of diabetes ‒ which includes availability of products such as insulin, syringes, oral hypoglycemic agents and blood testing equipment.
Costs range from relatively low-cost items, such as primary-care consultations and hospital outpatient episodes, to very high-cost items, such as long hospital inpatient stays for the treatment of complications. Overall, direct health care costs of diabetes range from 2.5% to 15 % annual health care budgets, depending on local diabetes prevalence and the sophistication of the treatment available.
For most countries, the largest single item of diabetes expenditure is hospital admissions for the treatment of long-term complications, such as heart disease and stroke, kidney failure and foot problems. Many of those are potentially preventable given prompt diagnosis of diabetes, effective patient and professional education and comprehensive long term care.
Besides excess healthcare expenditure, diabetes also imposes large economic burdens in the form of lost productivity and foregone economic growth. The largest economic burden is the monetary value associated with disability and loss of life as a result of the disease itself and its related complications.
Diabetes is one of the major causes of premature illness and death worldwide. Non-communicable diseases including diabetes account for 60% of all deaths worldwide. The number of deaths attributable to diabetes in 2010 shows a 5.5% increase over the estimates for the year 2007. This increase is largely due to a 29% increase in the number of deaths due to diabetes in the North America & Caribbean Region, a 12% increase in the South East Asia Region and an 11% increase in the Western Pacific Region.
WHO projects that globally, deaths caused by these health problems will increase by 17% over the next decade, with the greatest increase in low- and middle-income countries, mainly in the African (27%) and Eastern Mediterranean (25%) regions. Unless addressed, the mortality and disease burden from diabetes and other non-communicable diseases (NCDs) will continue to increase.
A number of diabetes patients may not be able to continue working or work as effectively as they could before the onset of their condition. Sickness, absence, disability, premature retirement or premature mortality also causes loss of productivity.
Estimating the cost to society of this loss of productivity is not easy. However, in many cases where estimates have been made, these costs of lost production may be as great or even greater than direct health care costs.
Combining the cost estimates for 25 Latin American countries suggests that costs of lost production may be as much as five times the direct health care cost. This may be because there is limited access to high quality care with consequently, a high incidence of complications, disability and premature mortality. Families too, of course, suffer loss of earnings as a result of diabetes and its consequences.
Pain, anxiety, inconvenience and other factors which decrease quality of life are intangible costs, which are just as heavy. Some activities may have to be foregone in favor of treatment, discrimination may be experienced in the workplace, obtaining jobs may be more difficult, and professional life may be shortened because of complications leading to early disability and even death.
Personal relationships, leisure and mobility can also be negatively influenced. Diabetes treatment, particularly insulin injection and self-monitoring, can be time-consuming, inconvenient and uncomfortable.
In developing countries, less than half of people with diabetes are diagnosed. Without timely diagnoses and adequate treatment, complications and morbidity from diabetes rise exponentially. Type 2 diabetes can remain undetected for many years and the diagnosis is often made from associated complications or incidentally through an abnormal blood or urine glucose test. Undiagnosed diabetes accounted for 85% of those with diabetes in studies from South Africa, 80% in Cameroon, 70% in Ghana and over 80% in Tanzania.
Type 2 diabetes is responsible for 85-95% of all diabetes in high-income countries and may account for an even higher percentage in low- and middle-income countries. Not surprisingly, diabetes is projected to become one of the world’s main disablers and killers within the next twenty-five years. Immediate action is needed to stem the tide of diabetes and to introduce cost-effective treatment strategies to reverse this trend. Such action, of course, will require expenditure on vast scale.