Article Text
Abstract
Background Diabetes imposes a huge social and economic impact on nations. However, information on the costs of treating and managing diabetes in developing countries is limited. The aim of this study was to estimate healthcare use and expenditure for diabetes in Bangladesh.
Methods We conducted a matched case–control study between January and July 2014 among 591 adults with diagnosed diabetes mellitus (DMs) and 591 age-matched, sex-matched and residence-matched persons without diabetes mellitus (non-DMs). We recruited DMs from consecutive patients and non-DMs from accompanying persons in the Bangladesh Institute of Health Science (BIHS) hospital in Dhaka, Bangladesh. We estimated the impact of diabetes on healthcare use and expenditure by calculating ratios and differences between DMs and non-DMs for all expenses related to healthcare use and tested for statistical difference using Student's t-tests.
Results DMs had two times more days of inpatient treatment, 1.3 times more outpatient visits, and 9.7 times more medications than non-DMs (all p<0.005). The total annual per capita expenditure on medical care was 6.1 times higher for DMs than non-DMs (US$635 vs US$104, respectively). Among DMs, 9.8% reported not taking any antidiabetic medications, 46.4% took metformin, 38.7% sulfonylurea, 40.8% insulin, 38.7% any antihypertensive medication, and 14.2% took anti-lipids over the preceding 3 months.
Conclusions Diabetes significantly increases healthcare use and expenditure and is likely to impose a huge economic burden on the healthcare systems in Bangladesh. The study highlights the importance of prevention and optimum management of diabetes in Bangladesh and other developing countries, to gain a strong economic incentive through implementing multisectoral approach and cost-effective prevention strategies.
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Footnotes
Handling editor Sanni Yaya
Contributors SMSI, the principal investigator, was involved in the concept, design, development of the study and the instruments, as well as in the implementation, analysis and reporting aspects of the study. RH, LWN and AL were involved in all aspects of the study and provided expert advice for the study design and writing of the manuscript. UF and JS were involved in the study design and review of the protocol. ML revised the protocol, assisted in data analysis and provided suggestions to improve the study design and manuscript. All authors have read and approved the final version of the manuscript.
Funding This research study was funded by ICDDR,B's core SIDA grant number GR-01014. ICDDR,B also gratefully acknowledges the following donors who provided unrestricted support: Australian Agency for International Development (AusAID), Government of the People's Republic of Bangladesh, Canadian International Development Agency (CIDA), Swedish International Development Agency (SIDA), and the Department for International Development, UK (DFID). SMSI also received support from the Center for International Health (CIH), Ludwig-Maximilians University of Munich, DAAD, BMZ and Exceed as a PhD scholar for this study.
Disclaimer The funding organisations had no role in the design and conduct of the study; collection, management, analysis and interpretation of data; preparation, review or approval of the manuscript; nor the decision to submit for publication.
Competing interests SMSI (MBBS, MPH, PhD) is a Senior Research Investigator at the Non-Communicable Diseases Unit, ICDDR, B and a Postdoc Research Fellow at the George Institute for Global Health, University of Sydney, Australia. He was a PhD Fellow at the Center for International Health, Ludwig-Maximilians-Universität (LMU), Munich, Germany. His research interests focus on developing low-cost sustainable solutions for diabetes and other non-communicable diseases. His research interests include large scale interventions study, clinical epidemiology, clinical trials, economic study and translational research on diabetes and cardiovascular diseases.
Patient consent Obtained.
Ethics approval ICDDR,B.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.