The cost of diabetes and diabetes care
Introduction
The continuously increasing length of the life span of individuals in combination with the growing number of the world population are two underlying factors to the expected explosion in the numbers of Type 2 diabetic patients. Another important factor is the currently ongoing change in life style towards a more western-oriented way of living. The expected numbers in total individuals worldwide for diabetes mellitus are estimated to be 221 millions for year 2010 [1] compared to about 124 millions in year 1997 (Fig. 1). The dominant part of diabetic persons was in 1997 represented by Type 2 diabetes (97%). WHO expects the numbers of adults (20 years and older) with diabetes (i.e. a mix of Type 1 and 2 diabetes) to rise to 300 millions by year 2025 from 135 millions in year 1995 [2] (Fig. 7). This means that the increase is about 120% over 30 years. Moreover, 80% of those individuals will be found in developing countries by year 2025.
The top three counties in the world with diabetes are in the following order: India, China and the USA (Fig. 2). Some recent reports regarding India accentuate this trend. There are great differences for the prevalence between different geographical areas as shown in Fig. 3. From this figure, we find that eight areas outside of Europe with a prevalence of 8% or more, including Brazil, India (Chennai), Singapore and Oman (urban parts) [3], [4], [5], [6], [7].
On the basis of available information on the expected trends regarding incidence and prevalence of diabetes mellitus, especially Type 2 diabetes, it is obvious that the effect of the disease needs to be considered carefully. This is especially true from two perspectives: the general world health perspective (affecting the daily life of individuals i.e. the quality of life (QOL) of single individuals), and the purchaser's perspective (public as well as private). Looking at the problem from an economical point of view, it is the complications due to diabetes, the treatment of the complications, as well as the prognosis to cure and stop the disease, that have to be focused. Also relevant from the economical point of view is the premature death due to diabetes.
Section snippets
Diabetic complications
On average, people with diabetes are three times more likely to be hospitalized compared to non-diabetic individuals [8]. The risk for different reasons for hospitalization is slightly diversified, venous complications being the least risky (l.7 times) and heart-related complications the most risky (3.1 times; Fig. 4). The risk of death for diabetic patients is higher compared to those without diabetes. It is 4.2 times higher for diabetic patients aged under 44, 4.4 times higher for those aged
Economic consequences
The economic consequences related to diabetes can be calculated in two ways: direct costs or direct costs plus indirect costs. The direct costs are calculated on the basis of the number of physician visits, home nursing visits, medicines used and transportation costs paid by others than the individual. The indirect costs represent the total loss to society due to morbidity and premature mortality; the loss is calculated on the basis of sick-leave days, employment situation, income, family home
Quality of life
Calculation of QOL changes due to treatment, but is able to provide important additional information (medical and economical information) on how the patient themselves experience diabetes as a disease and how they experience different kinds of therapies for their diabetes and late complications. However, so far the focus in diabetes studies has been on traditional economical variables rather than on QOL.
Studies on costs for diabetes and diabetes care
In 1994 in Sweden, three times more resources were spent on treating late complications compared to what was spent on controlling the disease [15]. So far four major studies on the cost for diabetes and diabetes care have been published: the Diabetes Control and Complication Trial (DCCT), the Stockholm Study, the UKPDS, and the Kumamuto Study. All four studies aimed at investigating the effect of better control of the blood sugar on late complications. On the basis of this information, a
Conclusions
Diabetes ought to be one of the major concerns for ministers of health, especially in developing countries, and in particular in India and China. To increase the spending for early detection and disgnosis as well as for intensified treatment of diabetes, as well as to improve the treatments are major concerns, if we want to cut the future costs incurred by under-treated diabetes. This seem also to be the trend among the international health policy makers with the World Health Organization and
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