The cost of diabetes in Latin America and the Caribbean in 2015: Evidence for decision and policy makers

Abstract

BACKGROUNDThe financial implications of the increase in the prevalence of diabetes in middle–income countries represents one of the main challenges to health system financing and to the society as a whole. The objective of this study was to estimate the economic cost of diabetes in Latin America and the Caribbean (LAC) in 2015.METHODSThe study used a prevalence–based approach to estimate the direct and indirect costs related to diabetes in 29 LAC countries in 2015. Direct costs included health care expenditures such as medications (insulin and oral hypoglycemic agents), tests, consultations, hospitalizations, emergency visits and treating complications. Two different scenarios (S1 and S2) were used to analyze direct cost. S1 assumed conservative estimates while S2 assumed broader coverage of medication and services. Indirect costs included lost resources due to premature mortality, temporary and permanent disabilities.RESULTSIn 2015 over 41 million adults (20 years of age and more) were estimated to have Diabetes Mellitus in LAC. The total indirect cost attributed to Diabetes was US$ 57.1 billion, of which US$ 27.5 billion was due to premature mortality, US$16.2 billion to permanent disability, and US$ 13.3 billion to temporary disability. The total direct cost was estimated between US$ 45 and US$ 66 billion, of which the highest estimated cost was due to treatment of complications (US$ 1 616 to US$ 26 billion). Other estimates indicated the cost of insulin between US$ 6 and US$ 11 billion; oral medication US$ 4 to US$ 6 billion; consultations between US$ 5 and US$ 6 billion; hospitalization US$ 10 billion; emergency visits US$ 1 billion; test and laboratory exams between US$ 1 and US$ 3 million. The total cost of diabetes in 2015 in LAC was estimated to be between US$ 102 and US$ 123 billion. On average, the annual cost of treating one case of diabetes mellitus (DM) in LAC was estimated between US$ 1088 and US$ 1818. Per capita National Health Expenditures averaged US$ 1061 in LAC.CONCLUSIONSDiabetes represented a major economic burden to the countries of Latin America and the Caribbean in 2015. The estimates presented here are key information for decision–making that can be used in the formulation of policies and programs to achieve greater efficiency and effectiveness in the use of resources for diabetes prevention in the 29 countries of LAC.

Prevalence of People at Risk of Developing Diabetes Mellitus and the Involvement of Community Pharmacies in a National Screening Campaign: A Pioneer Action in Brazil

“…Barcelo et al [4] found that, most of the direct costs of treating DM in Latin America are related to the treatment of complications. The cost of a patient without chronic complications with HbA1c > 10% is 2.4 times higher than that of a patient better controlled with HbA1c < 8%.…”

“…In addition to the high disease burden, DM has a high economic impact deriving from direct and indirect costs, with an annual estimated total cost of US $ 102 to 123 billion, including parameters such as premature mortality and temporary or permanent disability [1,2,4]. In Latin America, about 25% of health expenditures refer to the treatment of DM and its complications [4]. Brazil is one of the top 10 countries with the highest number of people with DM in the world and currently is the 5th in the ranking [5].…”

Multidisciplinary care of diabetic feet

“…Os custos diretos incluíram medicamentos, hospitalizações, consultas e tratamento de complicações que totalizaram U$24,6 bilhões e os custos indiretos, que se referem à perda de renda por incapacidade permanente ou temporária e morte prematura, totalizando U$19 bilhões. Dentre os 25 países incluídos nesta análise, o Brasil é o que tem os maiores custos relacionados à doença (2) . É importante ressaltar o ônus financeiro substancial que o diabetes impõe à sociedade, além dos custos que não podem ser mensurados, como dor e sofrimento, recursos dos cuidados prestados por cuidadores não remunerados e custos associados ao diabetes não diagnosticado (3) .…”

Challenges of the economic and social effects of diabetes in low‐ and middle‐income countries

“…In addition to increasing average annual costs for the management of diabetes and its complications, there are epidemiological changes associated with the increasing trend of the prevalence of diabetes and its complications in recent and future years. In economic terms, the epidemiological burden observed and expected for these countries represents a high financial burden for health systems, patients, families, and society as a whole …”

“…Unlike other diseases, in the case of diabetes the economic and social effects are associated not only with the direct costs of annual case management and the main complications of diabetes (nephropathy, retinopathy, peripheral vascular disease, cardiovascular disease, and neuropathy), but also, more importantly, with the indirect costs of premature mortality, temporary disability, and permanent disability attributable to diabetes …”