The Cost of Diabetes

The human, social and economic impact of diabetes

The global diabetes epidemic has devastating human, social and economic effects. The largest costs of diabetes worldwide are its devastating effects on families and national economies.

Impact on families and people with diabetes

Diabetes is expected to cause 3.8 million deaths worldwide in 2007, about 6% of total global mortality, about the same as HIV/AIDS. Using World Health Organization (WHO) figures on years of life lost per person dying of diabetes, this translates into more than 25 million years of life lost each year.

The International Diabetes Federation (IDF) estimates that the equivalent of an additional 23 million years of life are lost to the disability and to reduced quality of life caused by the preventable complications of diabetes.

People living with diabetes and their families feel the impact of diabetes most directly. They feel the often crushing expenses of diabetes treatments as costs are not subsidized, and family income is frequently reduced when diabetes interferes with work.

It is often the case that caring for diabetes steals valuable time from education, paid work and leisure. In many countries, individuals and families fear and experience the disability, reduced quality of life, and the lost years of life that untreated diabetes brings.

• People with diabetes face the near certainty, in many countries the stark reality, of premature death.
• Type 1 diabetes is particularly costly in terms of mortality in poor countries, where many children die because access to life-saving insulin is not subsidized by governments (who instead tax it heavily), and is often not available at any price.
• Studies recently carried out in Zambia, Mali and Mozambique highlight a stark reality: a person requiring insulin for survival in Zambia will live an average of 11 years; a person in Mali can expect to live for 30 months; in Mozambique a person requiring insulin will be dead within 12 months.
• In the poorest countries, people with diabetes and their families bear almost the entire cost of whatever medical care they can afford.
• In Latin America, families pay 40-60% of diabetes care costs out of their own pockets.
• In India, for example, the poorest people with diabetes spend an average of 25% of their income on private care. Most of this money is used to stay alive by avoiding fatally high blood sugar levels.

Impact on national economies

Diabetes affects all people in society, not just those who live with diabetes.

WHO estimates that mortality from diabetes, heart disease and stroke cost about 250 billion international dollars (ID) in China, ID225 billion in the Russian Federation, and ID210 billion in India in 2005. Much of the heart disease and stroke in these estimates was linked to diabetes.

WHO estimates that diabetes, heart disease and stroke together will cost about:

• $555.7 billion in lost national income in China over the next 10 years
• $303.2 billion in the Russian Federation
• $333.6 billion in India
• $49.2 billion in Brazil
• $2.5 billion even in a very poor country like Tanzania

These estimates are based on lost productivity, resulting primarily from premature death. Accounting for disability might double or triple these figures.

• If nothing is done, diabetes threatens to subvert the gains of economic advancement globally.
• Government budgets worldwide will face the immense strain of diabetes care on disability payments, pensions, social and medical service costs, and revenue.
• Private health insurers and employers will face the spiralling costs of treating the growing number of people with diabetes.

Because diabetes is increasing faster in the world’s developing economies than in its developed ones, it is the developing world that will bear the brunt of the future cost burden.

Disparities developed – developing world

• More than 80% of expenditures for medical care for diabetes are made in the world’s economically richest countries.
• Less than 20% of expenditures are made in the middle- and low-income countries, where 80% of people with diabetes will soon live.
• One country, the United States of America, is home to about 8% of the world’s population living with diabetes and spends more than 50% of all global expenditure for diabetes care.
• Europe accounts for another quarter of spending on diabetes care.
• The remaining industrialized countries, such as Australia and Japan, account for most of the rest.
• In the world’s poorest countries, not enough is spent to provide even the least expensive life-saving diabetes drugs.
• IDF’s new (and probably generous) estimates of national diabetes-care spending for 2007 include USD6 per person with diabetes in Burundi, USD10 in Tajikistan, USD78 in Guyana and USD48 in Haiti. Some of these amounts could not cover the annual wholesale price of a generic oral agent capable of preventing acute, life-threatening high blood sugar.
• The economic opportunities that the United Nations want to create for developing countries with its Millennium Development Goals, will be greatly undermined by the economic impact of diabetes.

If nothing changes, the disparity in spending for diabetes care between the industrialized countries and the rest of the world will only increase. Overall, world treatment costs for diabetes are growing more quickly than the world population.

Dramatic rise in medical care costs for diabetes

Diabetes is costly even before it is diagnosed. This is true both in industrialized and developing countries. In 2007, the world is estimated to spend at least US$ 232 billion to treat and prevent diabetes and its complications. By 2025, this lower-bound estimate will exceed US$ 302.5 billion.

Where the costs lie

• In industrialized countries, about 25% of medical expenditures for diabetes go to treating elevated blood sugar; 25% goes to treating long-term complications, largely cardiovascular disease, and 50% is consumed by the additional general medical care that is associated with diabetes.
• The cost, for example, of a person with diabetes who has end-stage kidney disease is 3 to 4 times higher than the cost of a person with diabetes and no complications.
• In the USA, acute hospitalization consumes 44% of diabetes-attributable costs; followed by:
• 22% for outpatient care
• 19% for drugs and supplies
• 15% for nursing care
• Similar proportions are reported for other high-income countries such as Finland.
• In middle-income countries, half of diabetes medical expenditures are used for blood sugar control, which is essential for the prevention of acute life-threatening hyperglycaemia. The remainder is split between general medical care and chronic complications.
• In Latin America and the Caribbean, for example, drugs to reduce blood sugar levels are believed to account for about 50% of all spending.
• It is believed that in low-income countries almost all expenditure for diabetes is directed towards drugs to prevent death from high blood sugar.

Access to care

Although the medical care costs of diabetes are much higher in industrialized countries, nearly all of these countries have organized medical care insurance systems and/or governmental provisions for medical services. This allows families to survive financially when diabetes strikes. However, costs in these countries are much higher than they need to be because insufficient money is invested to prevent expensive complications such as heart disease, stroke, kidney disease, and amputations.

In developing countries, however, people living with diabetes bear the brunt of the medical costs out of their own pocket because many countries lack an adequate healthcare infrastructure.

Source: All economic impact data are drawn from the Diabetes Atlas, third edition, International Diabetes Federation 2006.