Background
Methods
Overview of health systems in the WHO African region
Data
Group | GNI per capita (International Dollars, PPP) | Group GNI per capita(International Dollars, PPP) | Countries |
---|---|---|---|
1. | ≥ 8000 | 11,113 (standard deviation = 1,950; Median = 10,905) | Botswana, Equatorial Guinea, Gabon, Mauritius, Seychelles, South Africa |
2. | 2000–7999 | 3,995 (standard deviation = 1,664; median = 3,865) | Algeria, Angola, Cape Verde, Congo, Namibia, Swaziland |
3. | <2000 | 972 (standard deviation = 437; median = 1020) | Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, Democratic Republic of Congo, Cote d'Ivoire, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, Tanzania, Togo, Uganda, Zambia, Zimbabwe |
Conceptual framework
Definition of costs estimated
Analytical model
Direct costs
Insulin
Syringes
Reagent strips
Glucose meters
Oral drugs
Outpatient consultations and hospitalizations
Tests
Household out-of-pocket expenditures
Indirect costs
Cost of premature diabetes-related mortality (CPM)
Cost of diabetes-related permanent disability (CPD)
Total cost of productive time lost due to diabetes-related temporary disability (CTD)
Cost of productive time lost by caregivers (CPV)
Results
Group 1 countries total costs
GROUP 1 | GROUP 2 | GROUP 3 | ||||
---|---|---|---|---|---|---|
(A). Direct Cost of Diabetes | Sub-Total Cost (Int$) | % of grand total | Sub-Total Cost (Int$) | % of grand total | Sub-Total Cost (Int$) | % of grand total |
(1). Total annual cost of insulin | 301,619,560 | 2.71 | 216,465,240 | 8.47 | 3,787,564,806 | 32.06 |
(2). Total annual cost of syringes | 55,045,570 | 0.49 | 21,730,768 | 0.85 | 379,961,154 | 3.22 |
(3). Total annual cost of reagent strips | 79,265,620 | 0.71 | 31,292,306 | 1.22 | 547,144,062 | 4.63 |
(4). Total annual cost of glucose meters | 987,900 | 0.01 | 390,001 | 0.02 | 6,819,144 | 0.06 |
(5). Total cost of oral drugs | 12,818,831 | 0.12 | 12,651,474 | 0.49 | 243,016,810 | 2.06 |
(6). Total cost of OPD consultations | 155,638,707 | 1.40 | 78,781,280 | 3.08 | 110,057,519 | 0.93 |
(7). Total cost of hospitalization | 120,850,551 | 1.09 | 75,585,203 | 2.96 | 128,122,962 | 1.08 |
(8). Total cost diabetes related test all people | 82,442,680 | 0.74 | 48,295,109 | 1.89 | 1,036,388,236 | 8.77 |
(9). Monetary cost borne by households | 44,551,372 | 0.40 | 37,992,583 | 1.49 | 486,623,596 | 4.12 |
Total Direct Cost
| 853,220,791 | 523,183,964 | 6,725,698,289 | |||
(B) Indirect Cost of Diabetes | ||||||
(10). Cost of permanent disability | 9,055,480,160 | 81.33 | 1,791,388,406 | 70.06 | 4,482,451,114 | 37.94 |
(11). Cost of temporary disability | 109,022,465 | 0.98 | 21,567,225 | 0.84 | 53,965,981 | 0.46 |
(12). Cost of premature deaths among the productive | 998,019,608 | 8.96 | 197,431,911 | 7.72 | 494,018,431 | 4.18 |
(13). Productivity loss for care givers | 118,623,416 | 1.07 | 23,466,521 | 0.92 | 58,718,439 | 0.50 |
Grand total indirect cost =
| 10,281,145,649 | 2,033,854,063 | 5,089,153,966 | |||
GRAND TOTAL COST (A+B) | 11,134,366,440 | 100.00 | 2,557,038,027 | 100.00 | 11,814,852,255 | 100.00 |
Group 2 countries total costs
Group 3 countries total costs
Average costs
GROUP 1 | GROUP 2 | GROUP 3 | |
---|---|---|---|
Cost items | Cost per case diabetes per year | Cost per diabetes case per year | Cost per diabetes case per year |
(1). Total annual cost of insulin | 2,064.5 | 2,692.4 | 4,582.7 |
(2). Total annual cost of syringes | 376.8 | 270.3 | 459.7 |
(3). Total annual cost of reagent strips | 542.5 | 389.2 | 662.0 |
(4). Total annual cost of glucose meters | 6.8 | 4.9 | 8.3 |
(5). Total cost of oral drugs | 15.5 | 27.8 | 51.9 |
(6). Total cost of OPD consultations | 159.8 | 147.0 | 20.0 |
(7). Total cost of hospitalization | 827.2 | 940.1 | 155.0 |
(8). Total cost diabetes related test all people | 84.6 | 90.1 | 188.1 |
(9). Monetary cost borne by households | 45.7 | 70.9 | 88.3 |
(10). Cost of permanent disability | 116,215.1 | 41,776.8 | 10,168.9 |
(11). Cost of temporary disability | 121.7 | 43.7 | 10.6 |
(12). Cost of premature deaths among the productive | 63,599.6 | 22,862.7 | 5,565.0 |
(13). Productivity loss for care givers | 121.8 | 43.8 | 10.7 |
GRAND TOTAL COST
| 11,431.6 | 4,770.6 | 2,144.3 |
GROUP 1 | GROUP 2 | GROUP 3 | |
---|---|---|---|
Summary of direct Cost of Diabetes | Cost per diabetes patient (Int$) | Cost per diabetes patient (Int$) | Cost per diabetes patient (Int$) |
(1). Total annual cost of insulin | 309.7 | 403.9 | 687.4 |
(2). Total annual cost of syringes | 56.5 | 40.5 | 69.0 |
(3). Total annual cost of reagent strips | 81.4 | 58.4 | 99.3 |
(4). Total annual cost of glucose meters | 1.0 | 0.7 | 1.2 |
(5). Total cost of oral drugs | 13.2 | 23.6 | 44.1 |
(6). Total cost of OPD consultations | 159.8 | 147.0 | 20.0 |
(7). Total cost of hospitalization | 124.1 | 141.0 | 23.3 |
(8). Total cost diabetes related test all people | 84.6 | 90.1 | 188.1 |
(9). Monetary cost borne by households | 45.7 | 70.9 | 88.3 |
Total Direct Cost
| 876.0 | 976.1 | 1,220.6 |
Summary of Indirect Cost of Diabetes | |||
(10). Cost of permanent disability | 9,297.2 | 3,342.1 | 813.5 |
(11). Cost of temporary disability | 111.9 | 40.2 | 9.8 |
(12). Cost of premature deaths among the productive | 1,024.7 | 368.3 | 89.7 |
(13). Productivity loss for care givers | 121.8 | 43.8 | 10.7 |
Grand total indirect cost = | 10,555.6 | 3,794.5 | 923.6 |
GRAND TOTAL COST
| 11,431.6 | 4,770.6 | 2,144.3 |
Discussion
Limitations of the study
a) Disregard of complications in the costing of burden associated with diabetes
b) Assumption that those who suffer diabetes disability and mortality would have future earnings
c) Use of human capital approach
d) Assumption that all diabetes cases receive diagnostic tests
e) Omission of intangible costs
f) Use of per capita GNI to value-productive time lost
Conclusion
-
national-level epidemiological burden of diabetes, measured in terms of its prevalence, incidence, mortality, and, probably, disability-adjusted life years lost;
-
national-level economic burden of diabetes, broken down by different productive and social sectors and occupations of patients and relatives; and
-
national-level costs and effectiveness of alternative preventive, diagnostic and treatment interventions of diabetes to aid choice of cost-effective strategies.