Background
Methods
Study design and study population
Data collection instrument
Calculation of costs
Ethical approval
Statistical analysis
Results
General characteristics of the study participants
Variables | n (%) (n = 1253) |
---|---|
Gender | |
Male | 681(54.4) |
Female | 572 (45.6) |
Age (mean ± SD) | 55.1 ± 12.5 |
≤ 40 | 176 (14.05) |
41–60 | 669 (53.39) |
61–80 | 380 (30.33) |
≥ 80 | 28 (2.23) |
Education | |
Illiterate | 161 (12.8) |
Primary | 239 (19.1) |
Secondary | 566 (45.2) |
Tertiary | 287 (22.9) |
Work status | |
Unemployed | 36 (32.8) |
Employed | 411 (40.5) |
Housewives | 508 (23.8) |
Retired | 298 (2.9) |
Area of residence | |
Rural | 174 (13.9) |
Semi-urban | 162 (12.9) |
Urban | 917 (73.2) |
Monthly household income (US$) | |
≤ 250 | 447 (35.7) |
251–750 | 497 (39.7) |
751 and above | 309 (24.6) |
Duration of diabetes (in year) | |
≤ 5 | 360 (28.8) |
6–10 | 348 (27.7) |
≥ 11 | 545 (43.5) |
Mode of treatment | |
OHA | 432 (34.5) |
Insulin | 87 (6.9) |
Insulin + OHA | 734 (58.6) |
Family history of diabetes | 734 (58.7) |
Yes | 433 (34.6) |
No | 820 (65.4) |
HbA1c (%) | |
Good (≤6.9) | 182 (18.2) |
Fair (7–7.9) | 198 (19.8) |
Poor (≥8) | 621 (62.0) |
Number of complicationa | |
None | 458 (36.6) |
One or two | 613 (48.9) |
Three or more | 182 (14.5) |
History of co-morbidity | |
None | 296 (23.6) |
Hypertension | 524 (41.8) |
Dyslipidaemia | 151 (12.0) |
Hypertension + dyslipidaemia | 283 (22.6) |
Cost-of-illness by socio demographic and clinical characteristics
Variables | Direct cost | Indirect cost | Total cost | |||
---|---|---|---|---|---|---|
Mean | Median (percentiles) | Mean | Median (percentiles) | Mean | Median (percentiles) | |
Genderb | ||||||
Male | 795.2 | 456.1 (273.6, 893.4) | 81.6 | 19.5 (0, 62.5) | 876.9 | 497.9 (292.0, 977.3) |
Female | 765.7 | 446.6 (278.8, 905.2) | 84.4 | 52.1 (16.1, 93.7) | 850.1 | 516.89 (332.7, 988.3) |
Age (years)c | ||||||
≤ 40 | 519.6 | 331.1 (205.4, 564.9) | 68.8 | 41.6 (18.48, 72.91) | 588.4 | 385.7 (241.0, 616.2) |
41–60 | 738.7 | 421.1 (270.3, 784.7) | 103.0 | 52.1 (19.5, 104.2) | 841.8 | 476.2 (310.1, 860.1) |
61–80 | 934.9 | 587.4 (337.1, 1168.9) | 56.1 | 0 (0, 52.1) | 991.0 | 613.7 (351.3, 1247.3) |
> 80 | 1376.9 | 1052.1 (682.9, 1845.5) | 57.1 | 0 (0, 0) | 1434.1 | 1133.1 (712.2, 1936.1) |
Educationc | ||||||
Illiterate | 575.3 | 421.1 (254.1, 705.5) | 61.6 | 39.1 (3.6, 72.9) | 636.9 | 437.2 (287.5, 775.3) |
Primary | 759.5 | 513.1 (291.3, 958.0) | 59.3 | 31.2 (0, 72.9) | 818.9 | 536.41 (323.5, 1036.1) |
Secondary | 874.1 | 483.1 (294.7, 989.4) | 88.0 | 35.1 (0, 83.3) | 962.1 | 529.2 (333.7, 1092.1) |
Tertiary | 733.9 | 409.4 (224.6, 831.8) | 104.5 | 41.6 (0, 91.1) | 838.4 | 452.0 (261.2, 913.5) |
Work statusc | ||||||
Unemployed | 627.5 | 469.0 (298.7, 598.3) | 48.0 | 0 (0, 0) | 675.6 | 469.0 (298.7, 606.2) |
Employed | 598.9 | 343.1 (217.8, 607) | 116.0 | 41.6 (18.7, 87.5) | 715.0 | 393.3 (255.3, 700.7) |
Housewives | 798.9 | 488.3 (294.3, 936.7) | 87.0 | 52.1 (20.8, 104.1) | 885.9 | 533.6 (359.3, 1025.1) |
Retired | 1027.0 | 617.4 (369, 1189.9) | 34.8 | 0 (0, 10.9) | 1061.9 | 644.3 (374.2, 1298.3) |
Area of residencec | ||||||
Rural | 359.8 | 291.3 (202.4, 442.2) | 61.7 | 47.9 (11.4, 83.3) | 421.6 | 369.0 (239.6, 522.3) |
Semi-urban | 388.3 | 295.5 (228.1, 494.6) | 48.1 | 33.2 (7.8, 70.3) | 436.5 | 353.3 (253.7, 541.1) |
Urban | 931.3 | 545.3 (324.9, 1089.6) | 93.1 | 34.3 (0, 87.5) | 1024.4 | 590.3 (361.4, 1205.4) |
Monthly household income (US$)c | ||||||
≤ 250 | 739.6 | 465.5 (258.1, 846.1) | 65.2 | 31.2 (0, 78.1) | 804.9 | 499.4 (289.5, 920.3) |
251–750 | 692.1 | 407.9 (267.6, 757.3) | 64.6 | 41.66 (1.30, 72.9) | 756.8 | 456.5 (305.2, 810.7) |
751 and above | 986.8 | 571.8 (340.5, 1262.8) | 138.0 | 41.6 (0, 125.0) | 1124.9 | 499.4 (289.5, 920.3) |
Duration of diabetes (in year)c | ||||||
≤ 5 | 526.3 | 325.8 (220.8, 539.2) | 53.7 | 32.6 (10.4, 67.1) | 580.1 | 378.9 (260.2, 589.0) |
6–10 | 645.9 | 398.0 (258.3, 691.7) | 61.4 | 41.6 (3.9, 72.9) | 707.4 | 458.1 (292.5, 760.6) |
≥ 11 | 1044.1 | 679.8 (378.8, 1251.3) | 116.7 | 37.5 (0, 114.5) | 1160.8 | 746.6 (418.3, 1442.5) |
Mode of treatmentc | ||||||
OHA | 476.2 | 291.4 (209.6, 511.2) | 49.9 | 31.2 (4.0, 62.5) | 526.17 | 335.0 (238.7, 534.3) |
Insulin | 702.6 | 441.9 (224.3, 842.3) | 67.2 | 41.6 (8.8, 83.3) | 769.89 | 477.1 (259.8, 902.8) |
Insulin + OHA | 970.9 | 586.0 (368.9, 1129.6) | 104.2 | 41.6 (0, 104.1) | 1075.20 | 642.7 (412.4, 1223.7) |
Family history of diabetesb | ||||||
Yes | 818.4 | 487.3 (287.0, 964.3) | 97.1 | 41.6 (9.8, 93.7) | 915.6 | 524.3 (321.7, 1100.8) |
No | 762.4 | 441.4 (270.5, 879.9) | 75.4 | 31.2 (0, 72.9) | 837.9 | 493.1 (298.9, 954.2) |
HbA1c (%) | ||||||
Good (≤6.9) | 527.1 | 318.9 (205.9, 513.3) | 84.5 | 31.2 (0, 65.1) | 611.7 | 367.5 (234.2, 562.8) |
Fair (7–7.9) | 552.1 | 366.6 (242.3, 637.5) | 53.2 | 26.0 (0, 62.5) | 605.4 | 409.9 (277.8, 665.1) |
Poor (≥8) | 567.9 | 398.9 (267.2, 633.2) | 58.5 | 36.4 (7.8, 72.9) | 626.5 | 450.4 (300.7, 717.3) |
Number of complicationa,c | ||||||
None | 466.8 | 295.9 (207.3, 507.0) | 56.3 | 31.2 (15.6, 65.1) | 523.2 | 347.9 (237.8, 549.2) |
One or two | 657.5 | 379.9 (261.8, 670.7) | 81.9 | 36.4 (0, 83.3) | 739.4 | 437.1 (293.5, 739.7) |
Three or more | 1234.3 | 966.9 (511.1, 1519.8) | 117.1 | 43.7 (0,130.2) | 1351.5 | 1036.8 (547.8, 1718.5) |
History of co-morbidityc | ||||||
None | 595.5 | 354.2 (219.8, 580.7) | 63.8 | 31.2 (10.4, 72.9) | 659.3 | 418.2 (260.7, 632.8) |
Hypertension | 870.1 | 533.9 (317.5, 1041.9) | 94.3 | 41.6 (0, 91.1) | 964.4 | 582.4 (362.7, 1150.3) |
Dyslipidaemia | 566.8 | 332.6 (228.1, 561.9) | 56.9 | 27.3 (9.1, 62.5) | 623.7 | 376.1 (259.6, 608.8) |
Hypertension + dyslipidaemia | 926.9 | 534.0 (313.7, 1041.3) | 95.7 | 41.6 (0, 91.1) | 1022.6 | 587.6 (365, 1143.5) |
Annual cost-of-illness (COI) of diabetes care
Cost components | Mean | Median | 25thp, 75th p | 90th p | % of total | Total COI | % of total COI |
---|---|---|---|---|---|---|---|
Overall COI (n = 1263) | |||||||
a. Direct cost | |||||||
i. Direct medical cost | 96.9 | ||||||
Outpatient visit | 11.8 | 6.3 | 2.2, 12.5 | 31.2 | 1.5 | 14,807.1 | 1.4 |
Hospitalisationa | 216.7 | 496.6 | 0, 276.7 | 673.1 | 27.7 | 271,490.4 | 12.7 |
Medicine | 474.5 | 331.0 | 205.3, 474.5 | 798.4 | 60.7 | 594,543.8 | 54.9 |
Laboratory tests | 37.7 | 34.0 | 23.3, 47.2 | 62.1 | 4.8 | 47,311.9 | 16.8 |
Other service utilisation# | 16.5 | 9.0 | 0, 18 | 54.0 | 2.1 | 20,718 | 1.8 |
ii. Direct non-medical cost | 3.1 | ||||||
Transportation | 23.7 | 7.5 | 2.5, 27.5 | 62.5 | 3.0 | 29,748.7 | 2.8 |
Meal | 0.7 | 0.0 | 0, 0 | 2.5 | 0.1 | 931.4 | 0.1 |
Total direct cost | 781.7 | 453.6 | 276.6, 893.4 | 1705.0 | 100 | 979,551.3 | 90.5 |
b. Indirect cost | |||||||
Productivity loss of patient | 67.8 | 26.0 | 0, 62.5 | 145.8 | 81.8 | 85,062.5 | 7.9 |
Productivity loss of accompanied person | 15.1 | 0.0 | 0, 0 | 39.1 | 18.2 | 18,872.2 | 1.7 |
Total indirect cost | 82.9 | 36.5 | 0, 82.8 | 187.5 | 100 | 103,934.8 | 9.5 |
Total cost | 864.7 | 504.2 | 308.8, 982.7 | 1874.3 | 1,083,486.0 | ||
Without hospital admission (n = 813) | |||||||
Direct cost | |||||||
i. Direct medical cost | 93.9 | ||||||
Outpatient visit | 5.9 | 5.0 | 1.25, 8.75 | 12.5 | 1.6 | 4801.6 | |
Hospitalisationa | – | – | – | – | – | – | |
Medicine | 307.2 | 255.5 | 173.4, 387.8 | 520.1 | 83.5 | 249,827.3 | |
Laboratory tests | 34.2 | 31.2 | 21.5, 41.8 | 53.9 | 9.3 | 27,828.6 | |
Other service utilisationb | 10.5 | 9.0 | 0, 9 | 18.0 | 2.8 | 8523.0 | |
ii. Direct non-medical cost | 2.8 | ||||||
Transportation | 9.4 | 3.7 | 2, 8.75 | 21.0 | 2.6 | 7662.6 | |
Meal | 0.7 | 0.0 | 0, 0.6 | 2.3 | 0.2 | 524.5 | |
Total direct cost | 367.9 | 320.1 | 227.9, 452.8 | 608.9 | 100 | 299,167.5 | |
Indirect cost | |||||||
Productivity loss of patient | 34.7 | 24.7 | 0, 52.1 | 71.9 | 83.0 | 28,244.5 | |
Productivity loss of accompanied person | 7.1 | 0.0 | 0, 0 | 20.8 | 17.0 | 5790.9 | |
Total indirect cost | 41.8 | 31.3 | 3.9, 62.5 | 93.7 | 100 | 34,035.4 | |
Total cost | 409.8 | 366.6 | 261.9, 505.7 | 662.7 | 333,202.9 | ||
With hospital admission (n = 440) | |||||||
Direct cost | |||||||
i. Direct medical cost | 96.7 | ||||||
Outpatient visit | 22.7 | 12.5 | 5, 37.5 | 51.3 | 1.5 | 10,005.5 | |
Hospitalisationa | 617.0 | 419.4 | 247.3, 753.2 | 1303.9 | 39.9 | 271,490.4 | |
Medicine | 783.4 | 469.9 | 346.7, 764.0 | 1455.4 | 50.7 | 344,716.5 | |
Laboratory tests | 44.3 | 41.8 | 29.7, 56.9 | 71.6 | 2.9 | 19,483.4 | |
Other service utilisationb | 10.0 | 9.0 | 9, 36 | 54.0 | 1.8 | 12,195.0 | |
ii. Direct non-medical cost | 3.3 | ||||||
Transportation | 50.2 | 31.2 | 15, 62.5 | 112.5 | 3.2 | 22,086.1 | |
Meal | 0.9 | 0.0 | 0, 0 | 2.5 | 0.1 | 406.9 | |
Total direct cost | 1546.3 | 1121.1 | 806.3, 1845.9 | 2927.7 | 100.0 | 680,383.8 | |
Indirect cost | |||||||
Productivity loss of patient | 129.1 | 35.1 | 0, 145.8 | 281.2 | 81.3 | 56,818.1 | |
Productivity loss of accompanied person | 29.7 | 0.0 | 0, 0 | 104.1 | 18.7 | 13,081.2 | |
Total indirect cost | 158.9 | 67.7 | 0, 182.9 | 345.1 | 100.0 | 69,899.4 | |
Total cost | 1705.2 | 1247.4 | 876.9, 1996.6 | 3353.8 | 750,283.2 |
Sensitivity analysis
Determinants of cost-of-illness
Variables | Unadjusted | Adjusted | ||||
---|---|---|---|---|---|---|
Coefficients | p-value | 95% confidence interval (CI) | Coefficients | p-value | 95% confidence interval (CI) | |
Gender (ref: Male) | ||||||
Female | 19.03 | 0.492 | −35.32-73.37 | 44.85 | 0.036 | 3.02–86.68 |
Age (≤40 years) | ||||||
41–60 years | 82.85 | 0.107 | −17.79-183.49 | 21.13 | 0.419 | −30.13-72.39 |
61–80 years | 221.91 | < 0.001 | 113.60–330.24 | 2.86 | 0.930 | −60.70-66.41 |
≥ 80 years | 741.58 | < 0.001 | 499.87–938.30 | 170.76 | 0.708 | − 723.11-1064.64 |
Mode of treatment (ref: OHA) | ||||||
Insulin | 140.69 | 0.042 | 5.28–276.09 | 65.40 | 0.260 | −48.28-179.07 |
Insulin + OHA | 307.38 | < 0.001 | 237.90–377.65 | 152.87 | < 0.001 | 107.45–198.30 |
Duration of diabetes (ref: ≤5 year) | ||||||
6–10 | 78.36 | 0.080 | −9.42-166.15 | 17.59 | 0.403 | −23.68-58.82 |
≥ 11 | 368.68 | < 0.001 | 289.32–448.04 | 66.93 | 0.025 | 8.55–125.32 |
HbA1c (ref: ≤6.9) | ||||||
Fair (7–7.9) | 45.42 | 0.216 | −26.60-177.43 | −1.20 | 0.949 | −63.50-59.51 |
Poor (≥8) | 79.41 | 0.009 | 20.30–138.53 | 22.50 | 0.406 | −30.58-75.58 |
History of co-morbidity (ref: None) | ||||||
Hypertension | 164.89 | < 0.001 | 76.10–252.79 | 30.13 | 0.213 | −17.25-77.51 |
Dyslipidaemia | −42.17 | 0.494 | − 163.00-78.66 | 2.88 | 0.924 | −65.16-61.91 |
Hypertension+dyslipidaemia | 169.07 | 0.001 | 68.60–269.55 | 53.07 | 0.098 | −9.75-115.89 |
Number of complication (ref: None) | ||||||
One or two | 210.54 | < 0.001 | 134.48–28,660 | 63.69 | 0.003 | 21.70–105.68 |
Three or more | 847.72 | < 0.001 | 739.82–955.63 | 440.93 | < 0.001 | 274.08–607.85 |