[HTML][HTML] The economic costs of type 2 diabetes: a global systematic review
Background There has been a widely documented and recognized increase in diabetes
prevalence, not only in high-income countries (HICs) but also in low-and middle-income
countries (LMICs), over recent decades. The economic burden associated with diabetes,
especially in LMICs, is less clear. Objective We provide a systematic review of the global
evidence on the costs of type 2 diabetes. Our review seeks to update and considerably
expand the previous major review of the costs of diabetes by capturing the evidence on …
prevalence, not only in high-income countries (HICs) but also in low-and middle-income
countries (LMICs), over recent decades. The economic burden associated with diabetes,
especially in LMICs, is less clear. Objective We provide a systematic review of the global
evidence on the costs of type 2 diabetes. Our review seeks to update and considerably
expand the previous major review of the costs of diabetes by capturing the evidence on …
Background There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low-and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear. Objective We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, ie studies on the labour market impact of diabetes. Methods We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars ()adjustedfor2011values.Alongsidethenarrativesynthesisandmethodologicalreviewofthestudies,weconductanexploratorylinearregressionanalysis,examiningthefactorsbehindtheconsiderableheterogeneityinexistingcostestimatesbetweenandwithincountries.ResultsWeidentified86COIand23labourmarketstudies.COIstudiesvariedconsiderablybothinmethodsandincostestimates,withmoststudiesnotusingacontrolgroup,thoughtheuseofeitherregressionanalysisormatchinghasincreased.Directcostsweregenerallyfoundtobehigherthanindirectcosts.Directcostsrangedfrom 242 for a study on out-of-pocket expenditures in Mexico to 11,917forastudyonthecostofdiabetesintheUSA,whileindirectcostsrangedfrom 45 for Pakistan to 16,914fortheBahamas.InLMICs—instarkcontrasttoHICs—asubstantialpartofthecostburdenwasattributedtopatientsviaout-of-pockettreatmentcosts.Ourregressionanalysisrevealedthatdirectdiabetescostsarecloselyandpositivelyassociatedwithacountry’sgrossdomesticproduct(GDP)percapita,andthattheUSAstoodoutashavingparticularlyhighcosts,evenaftercontrollingforGDPpercapita.StudiesonthelabourmarketimpactofdiabeteswerealmostexclusivelyconfinedtoHICsandfoundstrongadverseeffects,particularlyformaleemploymentchances.Manyofthesestudiesalsotookintoaccountthepossibleendogeneityofdiabetes,whichwasnotthecaseforCOIstudies.ConclusionsThereviewedstudiesindicatealargeeconomicburdenofdiabetes,mostdirectlyaffectingpatientsinLMICs.Themagnitudeofthecostestimatesdiffersconsiderablybetweenandwithincountries,callingforthecontextualizationofthestudyresults.ScoperemainslargeforaddingtotheevidencebaseonlabourmarketeffectsofdiabetesinLMICs.Further,thereisaneedforfutureCOIstudiestoincorporatemoreadvancedstatisticalmethodsintheiranalysistoaccountforpossiblebiasesintheestimatedcosts.
Springer