As the number of people with diabetes grows worldwide, the disease takes an ever-increasing proportion of not only the patient’s household budgets but also the overall healthcare budget. Without primary prevention, the diabetes epidemic will continue to grow. Even worse, diabetes is projected to become one of the world’s main disablers and killers within the next twenty-five years. Immediate action is needed to stem the tide of diabetes and to introduce cost effective treatment strategies to reverse this trend.
THE SIZE OF THE PROBLEM
Diabetes is growing alarmingly in India, home to more than 65.1 million people with the disease, compared to 50.8 million in 2010.Rapid urbanization, demographic transition and lifestyle modifications are major causes for increase in the driving forces that lead to diabetes. By 2030, India’s diabetes numbers are expected to cross the 100 million mark according to a 2012 report by International Diabetes Federation.Diabetes is an expensive disease.The chronic nature of the disease and its associated complications are the real reason behind the high cost involved. In India, estimates suggest that 85-95% of all health care costs are borne by individuals and their families from household income as most people are not insured. The number of deaths due to diabetes is likely to be around 4,000,000 deaths year. Many of these diabetes related deaths will mostly be from cardiovascular complications.
COST OF ROUTINE DIABETES CARE
The costs involved in the care and management of diabetes are considerable for both the individual and the health care system.Caring for diabetics involves a direct cost borne by the affected individuals, their families and health care authorities. Studies in India estimate that, for a low income Indian family with an adult with diabetes, as much as 20 percent of family income may be devoted to diabetes care. For families with a diabetic child, up to 35 percent of income is spent on diabetes care. If you have Diabetes for five years you would have spent around Rs 1,50,000 on diabetes treatment only. After 10 years you would have spent Rs 4,00,000 and after 20 years you would have spent Rs 15,00,000. The increase in cost with time is due to the increase in complications. The costs of diabetes affect everyone, everywhere, and are a major financial problem.Indirect and intangible costs are larger. The indirect costs result from lost production as a result of frequent absence from work, an inability to work because of disabili ty, premature retirement and even premature mortality as a result of complications. Intangible costs are those that reduce the quality of life, because of pain, anxiety and stress. Not only do they have a great impact on the lives of the patients and their families but also they are the most difficult to quantify.
Direct costs to individuals and their families include medical care, drugs, insulin and other supplies.Physician and specialist consultations, laboratory tests and other tests like eye screening, foot screening, etc., that have to be undertaken from time to timealso constitute a major expense. The average monthly expense for a diabetic comes to be anywhere between Rs 3000 to Rs8000 per month. This can be further broken into the cost of consultation which will be Rs700, regular lab tests for Rs 500 and the medicine and insulin cost will be around Rs 6000.For an individual the estimated cost of routine care treatments ranges between Rs 35000 to Rs 75000 per annum (Lifespan data) depending on whether they are on oral drugs only or on insulin too. Patients may also have to bear other personal costs, such as increased payments for health, life and automobile insurance.The largest single item of diabetes expenditure is hospital admissions for the treatment of long-term complications, such as heart disease and stroke, kidney failure and foot problems.Patients with diabetes having foot complications spent on an average Rs 19020 month, and those who had end stage renal disease (Rs 12690 month), cardiovascular Rs13135 month) and retinal complications Rs13922 month.
INDIRECT COSTS (COSTS OF LOST PRODUCTION)
A number of diabetes patients may not be able to continue working or work as effectively as they could before the onset of their condition.
Sickness, absence, disability, premature retirement or premature mortality can cause loss of productivity. Estimating the cost to society of this loss of productivity is not easy. For a middle class family the loss of income is around Rs 50,000 per annum only because of increased sick days.The cost of lost production may be as much as five times the direct health care cost.
INTANGIBLE COSTS (LOSS OF PRODUCTIVITY)
The intangible costs include the costs that decrease quality of life. Pain, anxiety, inconvenience and other factors constitute intangible costs.Discrimination may be experienced in the workplace, obtaining jobs may be more difficult, and professional life may be shortened because of complications leading to early disability and even death.Personal relationships can also be negatively influenced.Diabetes treatment, particularly insulin injection and selfmonitoring, can be time-consuming, inconvenient and uncomfortable.
PREVENTION AND SAVING COST OF DIABETES
Effective prevention also means more cost-effective healthcare. The Indian diabetes prevention program evaluated the costeffectiveness of the interventions in primary prevention of diabetes.According to one study, the direct medical cost to identify one subject with IGT was Rs 5,278. Direct medical costs of interventions over the 3-year trial period were Rs 2,739 per subject in the control group, Rs 10,136 with lifestyle modification, Rs 9,881 with metformin, and Rs 12,144 with lifestyle modification and metformin.Cost-effectiveness to prevent one case of diabetes with lifestyle modification was Rs 47,341, with metformin Rs 49,280, and with lifestyle modification and metformin Rs 61,133. So we should direct our resources to preventing this costly disease.
Primary prevention protects susceptible individuals from developing diabetes. It has an impact by reducing or delaying the onset of Diabetes.This reduces both the need for diabetes care and the need to treat diabetic complications.
SECONDARY PREVENTION MEASURES
Secondary prevention includes early detection, prevention and treatment.The treatment of high blood pressure and raised blood lipids, as well as the control of blood glucose levels, can substantially reduce the risk of developing complications and slow their progression in all types of diabetes.Effective foot-care, eye screening and for urine are very cost effective measures.
Diabetes has already been described as an epidemic, but predictions for future increases in prevalence, especially in developing countries, point to a major health care crisis for the future. Very little is known about the economic impact of diabetes in the developing world where predicted increases in prevalence are greatest. With an estimated 40 million people suffering from the condition in India, diabetes has become a major health care problem in India. The high costs of treatment of diabetes amongst all socioeconomic patient groups will result in a serious burden on both patients and state resources alike. The long term economic implications are worrying. The considerable financial strain which households, particularly the poor, face in treating diabetes is alarming. As the burden due to diabetes increases in India, more households will be subject to these financial strains and unfortunately, the economically vulnerable among them will be the worst affected.While primary prevention of these conditions need more emphasis, in addition, insurance schemes targeted at the poor have an important role to play in financially protecting vulnerable households. With the Indian diabetic population predicted to rise to more than 80.9 million by the year 2030, immediate health policy restructuring and investment will be needed if the best use is to be made of scarce health care resources with accompanying economic constraints.