medwireNews: Both high- and middle-income countries have to bear significant direct and indirect costs associated with diabetes, a global analysis finds.
Overall, Christian Bommer (University of Goettingen, Germany) and co-researchers calculated a global diabetes economic burden of US$ 1.3 trillion (€ 1.2 trillion) for 2015, with 34.7% of this attributed to indirect costs of diabetes.
In a commentary accompanying the study in The Lancet Diabetes & Endocrinology, Ping Zhang and Edward Gregg, from the Centers for Disease Control and Prevention in Atlanta, Georgia, USA, say: “These results are an important reminder that diabetes is not only a global health problem because of its effect on mortality and morbidity and quality of life, but also a major problem for national economies.”
The factors underlying indirect costs differed by country income level, with the largest proportion caused by labor-force dropout in high-income countries (59.2%), but by mortality in middle-income (63.6%) and low-income (90.6%) countries. Absenteeism and presenteeism accounted for much smaller proportions of the indirect costs.
The study covers 184 countries from all World Bank regions, representing more than 7 billion people. The researchers used data from the 2015 IDF Diabetes Atlas and the 2015 Global Burden of Disease study, and also performed a systematic review to identify studies on which to base their calculations for expenditure and labor-market consequences.
The total costs of diabetes were highest in high-income countries, at US$ 804.36 billion (€ 737.71 billion), followed by middle- and low-income countries, at US$ 504.89 billion (€ 463.05 billion) and US$ 2.51 billion (€ 2.3 billion), respectively. But costs as a proportion of gross domestic product (GDP) were highest in middle-income countries, at 1.8%, compared with 1.2% and 0.7% in high- and low-income countries, respectively.
The most badly affected geographic area was North America, both in terms of total costs (US$ 499.40 billion; € 458.02) and proportion of GDP, at 2.6%. The least affected areas were sub-Saharan Africa and South Asia.
In their commentary, Zhang and Gregg anticipate further increases in direct diabetes expenditure because of increasing prevalence, decreasing mortality among diabetes patients, and the uptake of technology such as insulin pumps. They assume that indirect costs will also continue to rise in line with the increasing diabetes prevalence.
They say that cost-effective interventions are needed to combat the problem, but observe: “Unfortunately, most of what we know about the cost-effectiveness of diabetes interventions comes from selected high-income countries.”
They say: “Thus, decision-making is difficult for many countries in terms of how much money to invest in primary versus secondary prevention strategies, the appropriate population in which to intervene, and how to best implement primary intervention programmes.”
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