The Cost of Diabetes in NEWFOUNDLAND & LABRADOR

The Cost of Diabetes in NEWFOUNDLAND & LABRADOR

The Cost of Diabetes in Newfoundland and Labrador The Newfoundland and Labrador Diabetes Cost Model 1 In 2009, the Canadian Diabetes Association commissioned a report, An Economic Tsunami: the Cost of Diabetes in Canada, to determine the cost of diabetes in Canada, including the impact of lost productivity on the economy. The report also evaluated the potential benefits of initiatives designed to delay or prevent the onset of type 2 diabetes and reduce the occurrence and severity of complications arising from the disease. The diabetes cost model used in the 2009 report has since been adapted to provide an analysis of the costs of diabetes at provincial levels. The findings in this report are the preliminary findings concerning the costs of diabetes in Newfoundland and Labrador derived through the Newfoundland and Labrador Diabetes Cost Model. This is one of a series of reports issued on diabetes at a provincial level. The Association will continue to roll-out diabetes cost models across Canada. The Canadian Diabetes Association continues to lead the fight against diabetes as it works to find a cure. 1 The Newfoundland and Labrador Diabetes Cost Model was created for the Association by the Centre for Spatial Economics based on the Canadian Diabetes Cost Model developed by Informetrica Limited and made possible by an unrestricted educational grant provided by Novo Nordisk Canada Inc. The two main sources of data used for the estimate and forecasts come from the National Diabetes Surveillance System (NDSS) and Health Canada s study the Economic Burden of Illness in Canada (EBIC). The Model aimed to integrate the administrative prevalence and incidence estimates from NDSS with the economic cost estimates from EBIC. The Model supports analysis of the sensitivity of the prevalence and cost estimates to changes in demographic data, incidence and mortality rates by age and sex, and the average annual number of net general practitioner and specialist visits by people with diabetes. Assumptions made in this model are conservative and may understate the prevalence and cost of diabetes in the future, rather than to overstate it.

The Prevalence of Diabetes in Newfoundland and Labrador The Newfoundland and Labrador Diabetes Cost Model estimates 2 that 47,000 people in Newfoundland and Labrador have been diagnosed with either type 1 or type 2 diabetes in 2010 representing approximately 9.3% of the population. This number is expected to increase by 26,000 over the next decade to 73,000 or 14.4% of the population of Newfoundland and Labrador. Diabetes in Newfoundland and Labrador: 2000 to 2020 100 15.0% 80 12.0% Thousands of Patients 60 40 9.0% 6.0% Prevalence Rate 20 3.0% 0 2000 2010 2020 0.0% Persons with diabetes (left axis) Share of the population (right axis) Source: Newfoundland and Labrador Diabetes Cost Model Diabetes in Newfoundland and Labrador (Table 1) 2000 2010 2020 Persons with diabetes (left axis) 26 47 73 Share of population (right axis) 5.0% 9.3% 14.4% 2 The estimates provided in this report include the most current data available from all sources but should be viewed as preliminary and will be subject to revision based on continuing research and more complete data.

The Economic Burden of Diabetes in Newfoundland and Labrador The economic burden of diabetes in Newfoundland and Labrabor is estimated to be $254 million in 2010 (measured in 2009 dollars). This cost is expected to increase by 27% over the next decade to $322 million by 2020. Cost of Diabetes in Newfoundland and Labrador: 2000 to 2020 350 300 Millions of 2009 Dollars 250 200 150 100 $132 $214 $260 50 0 $62 $22 $40 2000 2010 2020 Direct costs Indirect costs Source: Newfoundland and Labrador Diabetes Cost Model Cost of Diabetes in Newfoundland and Labrador in Millions of 2009 Dollars (Table 2) 2000 2010 2020 Direct costs 22 40 62 Indirect costs 132 214 260

The direct costs of diabetes which account for 16% of the total cost of the $254 million in 2010 are led by hospitalization costs. Indirect mortality and disability costs account for 84% of the total cost attributed to diabetes by the Diabetes Cost Model. Economic Cost of Diabetes in Newfoundland and Labrador by Source in 2010 Projected total cost in 2010: $254 million 2009 dollars 1% - Net CVD Hospitalization 1% - Net Doctor Visits: General Practitioner 2% - Net Doctor Visits: Specialist 4% - Drugs/medications for Diabetes 8% - Direct Hospitalization 16% - Long-Term Disability 68% - Net Mortality Source: Newfoundland and Labrador Diabetes Cost Model Economic Costs of Diabetes in Newfoundland and Labrador in Millions of 2009 Dollars (Table 3) 2000 2010 2020 Direct Hospitalization 11 19 30 Net CVD Hospitalization 1 2 3 Net Doctor Visits: General Practitioner 2 4 6 Net Doctor Visits: Specialist 3 5 8 Drugs/medications for Diabetes 6 10 15 Net Mortality 109 173 206 Long-Term Disability 22 40 54 Total 154 254 322

The Factors Driving Diabetes Prevalence and Costs in Newfoundland and Labrador Over the next decade, population growth, an aging population, rising incidence rates and declining mortality rates will be responsible, in part, for the 26,000 net increase (a 62% rise) of people diagnosed with diabetes in Newfoundland and Labrador. Two-thirds of the increase is, however, locked-in based on the prevalence of diabetes and the province s current demographic structure due to the number of net new people diagnosed with diabetes in Newfoundland and Labrador each year. These same factors are also responsible for the projected $68 million increase in costs over the next decade. While declining mortality rates for persons with diabetes increases the prevalence of the disease over the period, it also decreases the cost of the disease associated with premature mortality. Factors Driving the Increase in Prevalence from 2010 to 2020 26,000 net new persons with diabetes projected over the period (62% rise) 0% - No Population Increase 8% - Constant Mortality Rates 9% - Constant Incidence Rates 16% - No Population Aging 67% - Current Demographic Structure Source: Newfoundland and Labrador Diabetes Cost Model

Factors Driving the Increase in Costs from 2010 to 2020 150 100 Millions of 2009 Dollars 50 0-50 -100 $22 = + + + + -150 Total Increase in Costs Contributions from: Current Demographic Structure Constant Incidence Rates Constant Mortality Rates No Population Aging No Population Increase Source: Newfoundland and Labrador Diabetes Cost Model

Appendix A: Cost of Diabetes The average annual cost of diabetes in Newfoundland and Labrador will grow 2.4% a year in inflation-adjusted dollars with direct costs rising significantly faster than indirect costs. Average Annual, Inflation Adjusted, Growth in the Cost of Diabetes in Newfoundland and Labrador between 2010 and 2020 Total Long-Term Disability Net Mortality Drugs/medications for Diabetes Net Doctor Visits: Specialist Net Doctor Visits: General Practitioner Net CVD Hospitalization Direct Hospitalization 0.0% 1.0% 2.0% 3.0% 4.0% 5.0%

The cost of diabetes is higher for males than females and is highest for the population between the ages of 45 and 74. Cost of Diabetes in 2010 35 Millions of 2009 Reference Year Dollars 30 25 20 15 10 5 0 01-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Total, males Total, females Direct, males Direct, females Indirect, males Indirect, females

Appendix B: Population Projection The population projection used for this analysis was the M1 projection for Newfoundland and Labrador from Statistics Canada s June 2010 projections (publication 91-520-X). The mean population of the province is expected to rise over the next decade contributing to the incidence and cost of diabetes. Population by Age Group 140 120 Insured Population (thousands) 100 80 60 40 20 0 01-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 2000 2010 2020

Appendix C: Prevalence Rates The following charts show the prevalence rates, by age and sex, of diabetes in Newfoundland and Labrador in each of 2000, 2010 and 2020. Prevalence rates will rise steadily over time for both males and females in each age group. Prevalence Rates: Males by Age Category 50 45 Prevalence Rate (cases per 100 population) 40 35 30 25 20 15 10 5 0 01-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 2000 2010 2020

Prevalence Rates: Females by Age Category 45 40 Prevalence Rate (cases per 100 population) 35 30 25 20 15 10 5 0 01-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 2000 2010 2020

Appendix D: Incidence Rates In 2010, incidence rates for males continue to rise until age 75-79 and for females until age 70-74 before moderating in the latter years. Incidence rates are higher for males than females from the age of 35 on. However; for women younger than 35, incidence rates are either the same or higher than for men. Incidence Rates by Sex, 2010 Incidence Rate (cases per 1,000 prevalence corrected population) 40 35 30 25 20 15 10 5 0 01-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Male Female

The following charts show the incidence rates, by age and sex, of diabetes in Newfoundland and Labrador in each of 2000, 2006 3, 2010 and 2020. Incidence rates are, in general, projected to be slightly below 2006 rates in 2010 and 2020 but are higher in 2020 than 2010. Incidence Rates: Males by Age Category Incidence Rate (cases per 1,000 Prevalence corrected population) 45 40 35 30 25 20 15 10 5 0 01-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 2000 2006 2010 2020 3 Data for 2006 was included because it is the last year of history available from NDSS.

Incidence Rates: Females by Age Category Incidence Rate (cases per 1,000 Prevalence corrected population) 40 35 30 25 20 15 10 5 0 01-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 2000 2006 2010 2020

Appendix E: Mortality Rates Mortality rates for persons with diabetes significantly exceed those for persons without the disease and are higher for males than females. The mortality rate is assumed to drop over the forecast period consistent with a decline in mortality rates for the population without diabetes. Mortality Rates per 1,000 50.0 45.0 40.0 35.0 Mortality Rate 30.0 25.0 20.0 15.0 10.0 5.0 0.0 With diabetes, both sexes Without diabetes, both sexes With diabetes, males Without diabetes, males With diabetes, females Without diabetes, females 2000 2010 2020

Unsurprisingly, mortality rates for persons, both with and without diabetes, rise with age and are consistently higher for persons with diabetes than for those without the disease. Mortality Rates in 2010 250.0 200.0 Mortality Rate 150.0 100.0 50.0 0.0 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ With diabetes, males Without diabetes, males With diabetes, females Without diabetes, females

About the Canadian Diabetes Association Today, more than nine million Canadians live with diabetes or prediabetes. Across the country, the Canadian Diabetes Association is leading the fight against diabetes by helping people with diabetes live healthy lives while we work to find a cure. Our community-based network of supporters help us provide education and services to people living with diabetes, advocate for our cause, break ground towards a cure and translate research into practical applications. For more information, please visit diabetes.ca or call 1-800-BANTING (226-8464). This initiative was supported by an unrestricted educational grant provided by We thank Novo Nordisk Canada Inc. for its ongoing commitment to diabetes in Canada.