Article Text
Abstract
Introduction The rising burden of diabetes in low- and middle-income countries may cause financial strain on individuals and health systems. This paper presents a systematic review of direct medical costs for diabetes (types 1 and 2) in low- and middle-income countries.
Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases (PubMed, International Bibliography of Social Science, EconLit) were searched for publications reporting direct medical costs of type 1 and 2 diabetes. Data were extracted from all peer-reviewed papers meeting inclusion criteria, and were standardised into per-patient-visit, per-patient-year and/or per-complication-case costs (2016 US$).
Results The search yielded 584 abstracts, and 52 publications were included in the analysis. Most articles were from Asia and Latin America, and most focused on type 2 diabetes. Per-visit outpatient costs ranged from under $5 to over $40 (median: $7); annual inpatient costs ranged from approximately $10 to over $1000 (median: $290); annual laboratory costs ranged from under $5 to over $100 (median: $25); and annual medication costs ranged from $15 to over $500 (median: $177), with particularly wide variation found for insulin. Care for complications was generally high-cost, but varied widely across countries and complication types.
Conclusion This review identified substantial variation in diabetes treatment costs; some heterogeneity could be mitigated through improved methods for collecting, analysing and reporting data. Diabetes is a costly disease to manage in low- and middle-income countriesand should be a priority for the global health community seeking to achieve Universal Health Coverage.
- diabetes
- health economics
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Footnotes
Handling editor Seye Abimbola
Contributors CM and VJW conceived the study, developed the research protocol and all data collection instruments, and led data collection and analysis. CL and ML participated in data collection and analysis. CM wrote the first draft of the manuscript with substantial input from VJW, and all authors provided feedback and edits. All authors approved of the final version for publication.
Funding The Leona M and Harry B Helmsley Charitable Trust and Stichting ICF funded the ACCISS study.
Disclaimer The analysis in this paper is that of the authors alone and does not necessarily reflect the views of the Helmsley Charitable Trust or Stichting ICF. All references and conclusions are intended for educational and informative purposes and do not constitute an endorsement or recommendation from the Helmsley Charitable Trust or Stichting ICF.
Competing interests VJW is coinvestigator of the Evaluation of Access Accelerated, an initiative that seeks to increase access to non-communicable disease treatments in low/middle-income countries. Her institution is receiving a grant to study the effects of this initiative. However, the publications of the results are not subject to control by the funding organisation, IFPMA (see also agreement http://sites.bu.edu/evaluatingaccessaccessaccelerated/agreements/). VJW is also co-PI of the study of Evaluation of Novartis Access, a programme that seeks to increase access to non-communicable diseases treatment in low/middle-income countries. Her institution is receiving a grant to study the effects of this programme. However, the publications of the results are not subject to control by the funding organisation, Sandoz International (see also agreement http://sites.bu.edu/novartisaccessevaluation/agreements/).
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.