What is the cost of diabetes care

WHAT IS THE COST OF DIABETES
CARE?
Diabetes management can be an
expensive affair. But by following a
proper regime you can reduce your
overall expenses
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• As the number of people with diabetes grows
worldwide, the disease takes an ever-increasing
proportion of not only the patient's household
budgets but also the overall healthcare budget.
Without primary prevention, the diabetes
epidemic will continue to grow. Even worse,
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.
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THE SIZE OF THE PROBLEM
• Diabetes is growing alarmingly in India, home to
more than 65.1 million people with the disease,
compared to 50.8 million in 2010.Rapid
urbanization, demographic transition and lifestyle
modifications are major causes for increase in the
driving forces that lead to diabetes. By 2030,
India's diabetes numbers are expected to cross
the 100 million mark according to a 2012 report
by International Diabetes Federation. Diabetes is
an expensive disease. The chronic nature of the
disease and its associated complications are the
real reason behind the high cost involved.
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Contd...
• In India, estimates suggest that 85-95% of all health
care costs are borne by individuals and their families
from household income as most people are not
insured. The number of deaths due to diabetes is likely
to be around 4,000,000 deaths year. Many of these
diabetes related deaths will mostly be from
cardiovascular complications.
• COST OF ROUTINE DIABETES CARE
• The costs involved in the care and management of
diabetes are considerable for both the individual and
the health care system.
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• Caring for diabetics involves a direct cost borne by the
affected individuals, their families and health care
authorities. Studies in India estimate that, for a low income
Indian family with an adult with diabetes, as much as 20
percent of family income may be devoted to diabetes care.
For families with a diabetic child, up to 35 percent of
income is spent on diabetes care. If you have Diabetes for
five years you would have spent around Rs 1,50,000 on
diabetes treatment only. After 10 years you would have
spent Rs 4,00,000 and after 20 years you would have spent
Rs 15,00,000. The increase in cost with time is due to the
increase in complications. The costs of diabetes affect
everyone, everywhere, and are a major financial
problem.Indirect and intangible costs are larger.
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Contd...
• The indirect costs result from lost production as a
result of frequent absence from work, an inability to
work because of disabili ty, premature retirement and
even premature mortality as a result of complications.
Intangible costs are those that reduce the quality of
life, because of pain, anxiety and stress. Not only do
they have a great impact on the lives of the patients
and their families but also they are the most difficult to
quantify.
• DIRECT COSTS
• Direct costs to individuals and their families include
medical care, drugs, insulin and other supplies.
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• Physician and specialist consultations, laboratory tests and
other tests like eye screening, foot screening, etc., that
have to be undertaken from time to timealso constitute a
major expense. The average monthly expense for a dia
betic comes to be anywhere between Rs 3000 to Rs8000
per month. This can be further broken into the cost of
consultation which will be Rs700, regular lab tests for Rs
500 and the medicine and insulin cost will be around Rs
6000.For an individual the estimated cost of routine care
treatments ranges between Rs 35000 to Rs 75000 per
annum (Lifespan data) depending on whether they are on
oral drugs only or on insulin too. Patients may also have to
bear other personal costs, such as increased payments for
health, life and automobile insurance.
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Contd...
• 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. Patients with diabetes
having foot complications spent on an average Rs
19020 month, and those who had end stage renal
disease (Rs 12690 month), cardiovascular Rs13135
month) and retinal complications Rs13922 month.
• INDIRECT COSTS (COSTS OF LOST PRODUCTION)
• 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.
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Contd...
• Sickness, absence, disability, premature retirement or
premature mortality can cause loss of productivity.
Estimating the cost to society of this loss of
productivity is not easy. For a middle class family the
loss of income is around Rs 50,000 per annum only
because of increased sick days. The cost of lost
production may be as much as five times the direct
health care cost.
• INTANGIBLE COSTS (LOSS OF PRODUCTIVITY)
• The intangible costs include the costs that decrease
quality of life. Pain, anxiety, inconvenience and other
factors constitute intangible costs.
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• 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 can
also be negatively influenced. Diabetes treatment,
particularly insulin injection and self monitoring, can be
time-consuming, inconvenient and uncomfortable.
• PREVENTION AND SAVING COST OF DIABETES
• Effective prevention also means more cost-effective
healthcare. The Indian diabetes prevention program
evaluated the cost effectiveness of the interventions in
primary prevention of diabetes.
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Contd...
• According to one study, the direct medical cost to
identify one subject with IGT was Rs 5,278. Direct
medical costs of interventions over the 3-year trial
period were Rs 2,739 per subject in the control group,
Rs 10,136 with lifestyle modification, Rs 9,881 with
metformin, and Rs 12,144 with lifestyle modification
and metformin.Cost-effectiveness to prevent one case
of diabetes with lifestyle modification was Rs 47,341,
with metformin Rs 49,280, and with lifestyle
modification and metformin Rs 61,133. So we should
direct our resources to preventing this costly disease.
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Contd...
• PRIMARY PREVENTION
• Primary prevention protects susceptible individuals from
developing diabetes. It has an impact by reducing or delaying the
onset of Diabetes. This reduces both the need for diabetes care and
the need to treat diabetic complications.
• SECONDARY PREVENTION MEASURES
• Secondary prevention includes early detection, prevention and
treatment. The treatment of high blood pressure and raised blood
lipids, as well as the control of blood glucose levels, can
substantially reduce the risk of developing complications and slow
their progression in all types of diabetes. Effective foot-care, eye
screening and for urine are very cost effective measures.
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Contd...
• Diabetes has already been described as an epidemic,
but predictions for future increases in prevalence,
especially in developing countries, point to a major
health care crisis for the future. Very little is known
about the economic impact of diabetes in the
developing world where predicted increases in
prevalence are greatest. With an estimated 40 million
people suffering from the condition in India, diabetes
has become a major health care problem in India. The
high costs of treatment of diabetes amongst all
socioeconomic patient groups will result in a serious
burden on both patients and state resources alike. The
long term economic implications are worrying.
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Contd...
• The considerable financial strain which households,
particularly the poor, face in treating diabetes is alarming.
As the burden due to diabetes increases in India, more
households will be subject to these financial strains and
unfortunately, the economically vulnerable among them
will be the worst affected. While primary prevention of
these conditions need more emphasis, in addition,
insurance schemes targeted at the poor have an important
role to play in financially protecting vulnerable households.
With the Indian diabetic population predicted to rise to
more than 80.9 million by the year 2030, immediate health
policy restructuring and investment will be needed if the
best use is to be made of scarce health care resources with
accompanying economic constraints.
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What is the cost of diabetes care

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