Distribution and determinants of healthcare costs for self-care behaviours among patients with type 2 diabetes across low-resource communities in Nepal

Abstract

Background Type 2 diabetes mellitus (T2DM) is a global public health problem, imposing significant financial burden on its’ management and care. Patients’ self-care behaviours can help to reduce the financial burden on healthcare resources. However, no studies have examined the distribution of healthcare costs related to self-care behaviours in low and lower middle-income countries. Therefore, this study aimed to explore the distribution and associated determinants of healthcare expenses incurred on self-care behaviours among patients with T2DM in low-resource communities in Nepal. Methods We conducted a cross-sectional study, collecting data from 481 patients with T2DM across low-resource communities in the Kavrepalanchok and Nuwakot districts of Nepal. We applied micro-costing with a bottom-up approach to estimate the healthcare costs for 6 month periods. Self-care behaviours were assessed using a self-reported questionnaire. The relationship between healthcare expenses and self-care behaviours was modelled by using a generalised linear model with an identity-link function and 10,000 bootstrapping resampling techniques. Results The average healthcare cost for managing T2DM is US $22.87 per patient for 6 months. Patients who engaged in footcare had the highest total expenses at US $71.98, followed by those who regularly conducted glucose monitoring (US $29.55), met physical activity recommendations (US $23.68), adhered to prescribed medication intake (US $23.59) and adhered to recommended dietary habits (US $22.98). Those patients who met the physical activity guidelines, regularly conducted glucose monitoring, and engaged in footcare had 18%, 32%, and 102% higher expenses respectively, compared to their counterparts. Conclusions Footcare was the most expensive and least practised component of self-care behaviour for managing T2DM, followed by glucose monitoring and physical activity, underscoring the significance of making these behaviours affordable and accessible in diabetes management. This provides valuable insight for decision-makers to prioritise and ensure these behaviours are affordable for patients with diabetes. Graphical Abstract