COSTS OF DIABETES IN DEVELOPING COUNTRIES

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1 COSTS OF DIABETES IN DEVELOPING COUNTRIES Jonathan Betz Brown, MPP, PhD Chair, International Diabetes Federation Task Force on Diabetes Health Economics Senior Investigator, Kaiser Permanente Center for Health Research, Portland, Oregon, USA

2 Complications of Diabetes Coronary Artery Disease Stroke Heart Failure Peripheral Neuropathy Peripheral Artery Disease Amputation Blindness Renal Failure Acute Hyperglycemic Symptoms Tuberculosis, HIV

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5 MILLIONS Global Deaths by Cause Deaths Diabetes 3.8 CVD 13.4 (w/ DM) HIV/AIDS 2.6 Malaria 1.2 Sources: International Diabetes Federation. Diabetes Atlas, Third Ed., World Health Organization. Global Burden of Disease Project. 2003

6 THOUSANDS, AGED Deaths from Diabetes AFR EMME EUR NA SACA SEA WP Source: International Diabetes Federation. Diabetes Atlas, Third Ed., 2006.

7 Health Care Expenditures for Diabetes, US Dollars 2002 Intern l $ USD 300 billion USD 350 billion Source: International Diabetes Federation. Diabetes Atlas, Third Ed., 2006

8 ESTIMATED DIABETES-CAUSED Spending Per Capita w/ DM, 2007 USA Burundi Cameroon Kenya Tanzania Nigeria South Africa USD ID Source: IDF Diabetes Atlas, Third Edition,

9 BILLIONS OF USD 2002, R= Health Expenditures for Diabetes WP / Western Pacific SEA / Southeast Asia South & Central America NA / North America EUR / Europe and Russia / East Med & Middle East AFR / Sub-Saharan Africa

10 KP s Annual Expenditures per Member 1% of members Annual expenditures for medical care - 36% of total expenditures for medical care Members ranked by expenditures

11 10 Most Frequent Conditions among the KP members incurring the highest annual expenditures for medical care (Top-1%) Conditions Diabetes only CHF only CHF + Diabetes + CAD CAD only Depression only CHF + Diabetes Diabetes + CAD CHF + CAD Asthma only Diabetes + Depression Sub-total % of Top-1% Costs 11% 8% 5% 5% 5% 4% 3% 3% 2% 1% 48% % of Top-1% Members 12% 5% 4% 6% 6% 3% 4% 2% 3% 1% 46%

12 Likely Annual Expenditures for Diabetes Care, USA, if complications not prevented $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 $0 Time Since Diagnosis

13 Evidence-Based Medicine Integrator (EBMI) 2 Prevention vs. No 2 Prevention over 40 years Male, Age 60, No CVD, Non Smoker, Newly Diagnosed Not currently treated for BP, Lipids, Blood Sugar, etc.

14 EBMI: Initial SBP=140mmHg, Treatment Threshold=140mmHg

15 EBMI: Initial LDL=140mg/dL, Treatment Threshold=100mg/dL, Statins

16 EBMI: Initial HbA1c=8%, Treatment Threshold= 8%/12%, metformin SU pioglitazone insulin

17 EBMI: Cumulative AMIs

18 EBMI: Survival Average Life Expectancy: 19.8 years Secondary Prevention 15.5 years No Secondary Prevention

19 EBMI: Total QALYs Quality Adjusted Life Expectancy: 19.0 QALYs Secondary Prevention (-0.8)( 14.2 QALYs No Secondary Prevention (-1.3)(

20 EBMI: Medical Expenditures Total Expenditures/1000 persons: $135.2 vs. $155.0 million Discounted: $91.4 vs. $107.6 million

21 EBMI: Expenditures per QALY Mean Expenditures per QALY: $7118 Secondary Prevention $10,911 No Secondary Prevention

22 3.0 DM/nonDM Total Expenditure Ratios Kaiser Permanente Northwest vs. U.S KPNW United States

23 Kaiser Permanente NW Medical Expenditure Ratios Age & Sex Matched Diabetes/Non-Diabetes Inpatient Outpatient 0.50 Pharmacy Total (n=6,703) 1995 (n=9,504) 2000 (n=14,725) 2005 (n=16,968)

24 BILLIONS OF USD, Lost Growth China India Russia Brazil Tanzania Source: World Health Organization. Preventing Chronic Diseases: A Vital Investment. 2005

25 Russian Federation Lost Economic Growth Lost Life Years (DALYs( DALYs) Expenditures for Medical Care

26 Lost Economic Growth Lost Life Years (DALYs( DALYs) Expenditures for Medical Care China

27 Dependency

28 Growth loss in developing countries Higher out-of of-pocket payments for care Poor access and quality of care death and disability family poverty and destitution lack of food and housing less schooling, less saving and investment increased social disorganization and communicable disease retarded economic development The poorer the country, the greater the loss?

29 Dependency

30 IDF Diabetes Impact Studies Population-Based Case-Control Comparisons 6 African countries, 6 Central American countries, Kazakhstan, China, more to come Individual and Family Expenditures, Access and Quality of Care, Disability, Sources of Payment, Change in Income and Wealth, Impact on Education and Nutrition

31 Summary Diabetes is costly, in money and lives. Preventing diabetes complications saves money, as well as lives. Economic impact might actually be much worse in developing countries but we have few data yet. Diabetes costs everyone.