Economic Burden of Diabetic Mellitus Among Patients on Follow-up Care in Hospitals of Southwest Shewa Zone, Central Ethiopia

Abstract

Background Diabetes has emerged as one of the most serious health issues of the twenty-first century. Diabetes and its complications expose individuals and their families to catastrophic healthcare costs, which have a severe impact on the country's economy. Though the prevalence of diabetes is rising quicker in Ethiopia, little is known about its economic impact. Hence, this study aimed to determine the total cost of diabetic mellitus and associated factors among patients attending hospitals in Southwest Shewa zone, Central Ethiopia. Methods The study was conducted among diabetes patients who were on care and treatment from September to October 2020. Direct costs were calculated using the micro-costing technique, while indirect costs were calculated using the human capital approach. The statistical significance of cost difference between the groups of patient characteristics was determined using Wilcoxon and Kruskal-Wallis mean rank sum tests, and the factors associated with a total cost of illness were identified with Generalized Linear Model (GLM). Results Out of the planned patients, 398 have responded and were included in the analysis; making a response rate of 98.5%. The mean monthly total cost of diabetic mellitus was US$ 37.7(95% CI, 23.45–51.95). Direct and indirect costs constituted 76.2% and 23.8% of the total cost, respectively. The mean direct and indirect cost of diabetic mellitus per patient per month was US$ 28.73(95% CI, 17.17–40.29) and US$ 9.50 (95% CI, 1.99–16.99) respectively. Statistical mean cost differences were observed by gender, age groups, family size, and comorbidities. The total cost of illness was associated with residence (p=0.007), family size (p=0.001), presence of co-morbidities (p=0.04), and history of ever-stopping treatments (p<0.0001). Conclusions The total cost of diabetes condition was relatively high compared to other related literatures. The medical expenditures accounted for most direct costs for diabetic patients. As a result, the government should provide sufficient resources to safeguard patients against catastrophic medical costs. Efforts should be made to enhance access to diabetes care, and the supply of diabetic medications at all levels of health facilities.

Prevalence of Glycemic Control and Factors Associated With Poor Glycemic Control: A Systematic Review and Meta-analysis

“…A recent study on the financial impact of diabetes revealed that diabetic care costs US $ 38.23 per month, which is more than a significant portion of the Ethiopian population earns on a monthly basis. 102 Therefore, socio-economic empowerment of patients could be vital to trim the burden of DM in Ethiopia.…”

Relationship of oral bacterial number with medical hospitalization costs in analysis of Diagnosis Procedure Combination database from single institution in Japan

“…Furthermore, hospital-acquired and ventilator-associated pneumonia cases that required intensive care have been found to have increased hospitalization time and costs 21,22 . The impact of development of DM and infectious complications in DM patients on hospitalization costs has also been frequently reported [23][24][25] . In other studies, oral bacterial infection and poor oral health were shown to be risk factors related to surgical site infection after various cancer and cardiovascular surgical procedures 9,[26][27][28][29] , while a relationship between oral microbial colonization and ventilator-associated pneumonia in patients in intensive care units has also been reported 30,31 .…”

Access to essential medicines for diabetes care: availability, price, and affordability in central Ethiopia

“…When EMs remain unaffordable, patients may forgo their treatment especially if they are paying out-of-pocket for their medicines, which increases the burden of DM and its complications [ 38 ]. The findings from an economic study in the same region has reported as to how the medicines cost constitute a high portion from the total cost of diabetes, which has implications both at the individual patients and societal levels [ 39 ]. In order to enhance access to EMs and protect citizens from the devastating diabetes complications and financial risk that have huge effect on public health, the country should work to make health care financing sustainable for its efficient operation.…”