|Fact sheet No 236: The Cost of Diabetes - November 1999 (WHO, 1999, 3 p.)|
As the number of people with diabetes grows worldwide, the disease takes an ever-increasing proportion of national health care budgets. And, without primary prevention, the diabetes epidemic will continue to grow. Even worse, diabetes is projected to become one of the worlds 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 care and profitable treatment strategies to reverse this process.
According to WHO, only prevention through education and a healthy lifestyle, as well as action taken early in the course of diabetes, are realistically cost-effective, and may improve drastically patients quality of life. This is especially the case because, once diabetes complications develop, the majority of low-income countries do not have the necessary resources to treat patients. In this case, the only outcome for individuals with diabetes is a painful and distressing life and early death.
Diabetes: the size of the problem
A diabetes epidemic is underway. An estimated 30 million people worldwide had diabetes in 1985. By 1995, this number had shot up to 135 million. Now, WHO predicts a rise to an alarming 300 million by 2025. This situation is increasingly outstretching the health-care resources devoted to diabetes.
For WHO and the International Diabetes Federation, sponsors of World Diabetes Day, this two-fold increase can and must be prevented with the right measures. Without effective preventive measures, the diabetes epidemic will continue to grow.
What are the costs of diabetes?
Because of its chronic nature, the severity of its complications and the means required to control them, diabetes is a costly disease, not only for the affected individual and his/her family, but also for the health authorities. WHO estimates that, for a low-income Indian family with an adult with diabetes, 25% of income will be devoted to diabetes care. For the USA, the corresponding figure is 10%. WHO also estimates that the total health care costs of a person with diabetes in the USA are three times those for people without the condition. It is calculated, for example, that the cost of treating a person with diabetes over a period of three years in the USA comes to around US$ 10,500.
The costs of diabetes affect everyone, everywhere, but they are not only a financial problem. Intangible costs also have great impact on the lives of patients and their families and are the most difficult to quantify.
Direct costs to individuals and their families include medical care, drugs, insulin and other supplies. Patients may also have to bear other personal costs, such as increased payments for health, life and automobile insurance. Last, but not least, in many cases there is also a potential loss of earnings.
Direct costs to the healthcare sector include hospital services, physician services, lab tests and the daily management of diabetes - which includes availability of products such as insulin, syringes, oral hypoglycaemic agents and blood-testing equipment. Costs range from relatively low-cost items, such as primary-care consultations and hospital outpatient episodes, to very high-cost items, such as long hospital inpatient stays for the treatment of complications.
Direct costs to society
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.
Pain, inconvenience and anxiety are intangible costs, which are just as heavy. Individuals quality of life is affected as a whole and life expectancy can be significantly reduced. Some activities may have to be foregone in favour of treatment, 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, leisure and mobility can also be negatively influenced. And, diabetes treatment can be time-consuming, inconvenient and uncomfortable.
Diabetes is a life-long condition, which requires careful control if the individual is to live a full and normal life. In the long-term, the disease may lead to complications such as blindness, kidney failure and limb amputation, as well as to heart disease and stroke.
The truth is that most of the direct costs of diabetes result from its complications. And, if the predicted increase in the number of persons with complications takes place, the implications for the health services will be grave.
Research has shown that hospital admission is the major cost factor for the health-care sector. The solution is to be found in promoting increased awareness of diabetes and improved self-care for those living with the condition. In this way, the need for hospital stays could be reduced significantly, thus enabling scant resources to be dedicated to other aspects of diabetes care.
The prevention of diabetes:
In diabetes, effective prevention means more cost-effective healthcare. This may be prevention of the onset of diabetes itself (primary prevention) or the prevention of its immediate and longer-term consequences (secondary prevention).
Primary prevention protects susceptible individuals from developing diabetes. It has an impact by reducing both the need for diabetes care and the need to treat diabetic complications. A reliable example of this measure is a study undertaken among a susceptible population in China. Lifestyle modifications (appropriate diet and increased physical activity and a consequent reduction of weight), supported by a continuous education programme, were used to achieve a reduction of at least one third in the progression to diabetes over a six-year period.
This type of measure is easy and low-cost and can be used in even the poorest regions of the world and when resources are limited.
Secondary prevention includes early detection, prevention and treatment. Appropriate action taken at the right time is beneficial in terms of quality of life, and is very cost-effective, especially if it can prevent hospital admission.
Secondary prevention measures:
· The monitoring 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.
· Another finance-saving strategy is the prevention of foot ulceration and amputation. Effective foot-care reduces both the frequency and length of hospital stays and the incidence of amputation in diabetes patients by as much as 50%.
· Screening and early treatment for retinopathy is also very cost-effective, given the devastating direct, indirect and intangible costs of blindness.
· Screening for protein in urine is another valid preventive measure to prevent or slow down the inevitable progression to kidney failure. Furthermore, there is evidence that screening for traces of protein is cost saving, as it allows even earlier intervention in the natural course of kidney disease.
For further information, journalists can contact:
WHO Press Spokesperson and Coordinator, Spokespersons Office,
WHO HQ, Geneva, Switzerland/Tel +41 22 791 4458/2599/Fax +41 22 791 4858/e-Mail: firstname.lastname@example.org
For technical information, please contact Dr. H. King, Chief,
WHO Diabetes Programme Tel. (41 22) 791 3472 or 791 2445. E-mail: