Global and regional estimates and projections of diabetes-related health expenditure: Results from the International Diabetes Federation Diabetes Atlas, 9th edition

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Abstract

Aims

Diabetes and its complications have a significant economic impact on individuals and their families, health systems and national economies.

Methods

The direct health expenditure of diabetes was calculated relying on the following inputs: diagnosed and undiagnosed diabetes prevalence estimates, United Nations population estimates, World Health Organization health expenditure per capita and ratios of health expenditure for people with diabetes compared to people without diabetes.

Results

The estimated global direct health expenditure on diabetes in 2019 is USD 760 billion and is expected to grow to a projected USD 825 billion by 2030 and USD 845 billion by 2045. There is a wide variation in annual health expenditures on diabetes. The United States of America has the highest estimated expenditure with USD 294.6 billion, followed by China and Brazil, with USD 109.0 billion and USD 52.3 billion, respectively. The age group with the largest annual diabetes-related health expenditure is 60–69 years with USD 177.7 billion, followed by 50–59 years, and 70–79 years with USD 173.0 billion and USD 171.5 billion, respectively. Slightly higher diabetes-related health expenditure is seen in women than in men (USD 382.6 billion vs. USD 377.6 billion, respectively). The same difference is expected to be present in 2030 and 2045.

Conclusions

There were large disparities between high-, middle- and low-income countries with total health expenditures in high-income countries being over 300 times those in low-income countries. The ratio for annual direct health expenditure per person between these groups of countries is more than 38-fold.

Introduction

The International Diabetes Federation (IDF) Diabetes Atlas has drawn attention to the economic impact of diabetes since its first edition in 2000 [1]. The first country- and Region-specific and global estimates of diabetes-related health expenditures were published in the second edition in 2003 [2] with full details about the methods used and updated estimates and projections in the third edition [3].

The most recent edition of the IDF Diabetes Atlas (9th edition) [4] has set out to update these estimates using contemporary epidemiological data and more sophisticated economic methods. This paper summarises these findings.

The significant economic impact of diabetes and, particularly, both its acute and long-term complications on health expenditures are well known, from early estimates reported from pan-European studies [5] to, for example, the most recent assessment for the United States of America [6]. In this assessment, the costs of hospital admissions for these complications is the over-riding influence. Since many of these complications can be prevented, or at least lessened in impact or delayed, their economic impact can potentially be significantly reduced and resources diverted to preventive measures or to other health priorities. The importance of addressing socio-economic disadvantage in the prevention of type 2 diabetes mellitus has recently been highlighted by Spencer Bonilla et al [7].

As examples, the costs of treating a single case of diabetic ketoacidosis (DKA) in the United Kingdom is estimated to be GBP 1,387 (around USD 1,750) [8]. In the United States of America, diabetes-related Chronic Kidney Disease (CKD) increases mean annual healthcare expenditures by 49% among people with diabetes and clinical nephropathy than among those with no nephropathy and, for people with diabetes undergoing dialysis, the mean annual figure increased 2.8 times compared with end-stage renal disease (ESRD) patients not on dialysis [9]. Neurological and / or vascular damage to the lower limb resulting in the “diabetic foot” have been described as the most costly of diabetes-specific complications. Compared to people with diabetes without foot ulcers, health expenditures for people with diabetes and foot ulcers is 5.4 times higher in the year of the first episode and 2.6 times higher in the year of the second episode and compared to people without diabetes [10]. Furthermore, the cost of care for people with diabetes and coronary heart disease or congestive heart failure is higher [11].

It is clear, therefore, that the treatment of complications is a major contributor to health expenditures related to diabetes. This contribution has been estimated to be 53% of total direct costs in Germany [12] and, coincidentally, also 53% in the United States of America [13]. These costs are clearly related to the number of complications present, with mean annual health expenditures for people with four or more complications 20 times more than in people with diabetes but without complications [14].

The aims of this paper, therefore, are (1) to draw attention to these recent IDF global estimates and projections of the direct costs of diabetes care in adults 20–79 years; (2) to provide details of the methods used in the formulation of these estimates and projections so that, with critical discussion, their precision can be improved and (3) to compare these results with others which have used different approaches.

Section snippets

Methods

The methods used in estimating diabetes-related health expenditures has remained basically consistent, with some minor modifications since their description in detail in the third edition of the IDF Diabetes Atlas [3]. The focus of this paper is on direct medical costs attributable to diabetes, which represent the opportunity costs of health care resources used for treating diabetes, diabetes-related complications, and comorbidity. Direct medical costs include hospital inpatient care, physician

Global estimates and projections to 2030 and 2045 and temporal trends since 2006

In 2019, total, world-wide diabetes-related health expenditure was estimated to be USD 760 billion in adults aged 20–79 years, with the majority of the spending among those aged 50–79 years (68.7% of that for all ages). The health expenditure is expected to grow to a projected USD 825 billion per year by 2030 and USD 845 billion by 2045 (Fig. 1).

Despite the fact that some modifications have been made to the methods used for these 2019 estimates (see Discussion below), they are in line with

Global estimates and projections to 2030 and 2045 and temporal trends since 2006

A recent comparable estimate of the global economic impact of diabetes is that of Bommer et al [18]. Their estimate of total costs in the age group 20–79 (in 2015) was USD 1.31 trillion (95% CI 1.28–1.36) amounting to around 1.8% of global GDP. Of this total, they estimated that 65.3% (USD 0.86 trillion (95% CI 0.83–0.89)) could be attributed to direct costs. Despite some minor differences in the methods used (for example differences in the handling of the relevant WHO data), similar

Conclusion

There are three main methods used to estimate health expenditures attributed to a given condition. These are: the top-down approach, the bottom-up approach and econometric approaches [31]. All methods are valid and the selection of a particular method depends on data availability. In this case a version of the top down approach was used since the data required by this approach is the most available for nearly all countries. The most notable improvement in this latest group of estimates and

Declaration of Competing Interest

The authors declared that there is no conflict of interest.

Acknowledgements

The contributions of other members of the IDF Diabetes Atlas Committee are gratefully acknowledged.

Author contribution

All authors contributed to the identification of studies, the analysis of health expenditure estimates and projections and the writing of the paper. All authors have read and approved the final manuscript.

Role of funding source

The 9th edition of the IDF Diabetes Atlas was supported by the educational grants from the Pfizer-MSD Alliance, with an additional support of Lilly Diabetes and Novo Nordisk.

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