The costs of diabetes treatment in low- and middle-income countries: a systematic review

Abstract

IntroductionThe rising burden of diabetes in low- and middle-income countries may cause financial strain on individuals and health systems. This paper presents a systematic review of direct medical costs for diabetes (types 1 and 2) in low- and middle-income countries.MethodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases (PubMed, International Bibliography of Social Science, EconLit) were searched for publications reporting direct medical costs of type 1 and 2 diabetes. Data were extracted from all peer-reviewed papers meeting inclusion criteria, and were standardised into per-patient-visit, per-patient-year and/or per-complication-case costs (2016 US$).ResultsThe search yielded 584 abstracts, and 52 publications were included in the analysis. Most articles were from Asia and Latin America, and most focused on type 2 diabetes. Per-visit outpatient costs ranged from under $5 to over $40 (median: $7); annual inpatient costs ranged from approximately $10 to over $1000 (median: $290); annual laboratory costs ranged from under $5 to over $100 (median: $25); and annual medication costs ranged from $15 to over $500 (median: $177), with particularly wide variation found for insulin. Care for complications was generally high-cost, but varied widely across countries and complication types.ConclusionThis review identified substantial variation in diabetes treatment costs; some heterogeneity could be mitigated through improved methods for collecting, analysing and reporting data. Diabetes is a costly disease to manage in low- and middle-income countriesand should be a priority for the global health community seeking to achieve Universal Health Coverage.

Comparative impact of pharmacological treatments for gestational diabetes on neonatal anthropometry independent of maternal glycaemic control: A systematic review and meta-analysis

“…Examining in detail the mechanisms by which the various pharmacological options for GDM treatment may impact the developing fetus and/or placenta in both the short and long term is particularly important, given the increasing incidence of GDM worldwide [1,2]. Most significantly, the greatest increases in GDM globally are occurring in populations in which treating GDM with insulin is unlikely to be feasible for large numbers of women [72]. Further understanding of how oral anti-hyperglycaemic agents impact on fetal growth trajectory and later life outcomes should therefore be a research priority.…”

Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses

“…Cost of hypoglycemic episodes was reported in studies from Spain, Italy, Canada, and China [188][189][190][191][192][193]. In Spain, the mean annual direct cost of hypoglycemia leading to hospitalization was approximately €11,000 among those who experienced such an event [188].…”

“…This was approximately 3 times higher compared to patients who did not experience hypoglycemia. In Italy, hospital episode cost of hypoglycemia varied between €547 and €3,145, depending on the patient age and comorbidity profile [189,190]. In Canada, patients who experienced hypoglycemic events incurred additional annual direct costs of €3,859 per patient [191].…”

Does disease management for diabetic nephropathy reduce medical expenditure? Evidence from a three-period difference-in-differences analysis

“…Diabetes is a major public health concern and is responsible for a huge social cost in both developed [1,2] and low-income countries [3]. Disease management for diabetes (DMD) has long been thought to be effective in preventing disease-related complications and to subsequently lead to cost savings [4][5][6][7], although the results of existing studies have been mixed because of poor design of interventional programs, small sample sizes, and relatively short evaluation periods to detect changes in disease prognosis [8].…”