Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May 18;12(5):e0176128.
doi: 10.1371/journal.pone.0176128. eCollection 2017.

Direct and indirect costs of diabetes mellitus in Mali: A case-control study

Clara Bermudez-Tamayo  1   2 , Stéphane Besançon  3 , Mira Johri  4   5 , Sidibe Assa  6 , Jonathan Betz Brown  7 , Kaushik Ramaiya  8
Affiliations

Direct and indirect costs of diabetes mellitus in Mali: A case-control study

Clara Bermudez-Tamayo et al. PLoS One. .

Abstract

Background: Diabetes mellitus (DM) is one of the most burdensome chronic diseases and is associated with shorter lifetime, diminished quality of life and economic burdens on the patient and society as a result of healthcare, medication, and reduced labor market participation. We aimed to estimate the direct (medical and non-medical) and indirect costs of DM and compare them with those of people without DM (ND), as well as the cost predictors.

Methods and findings: Observational retrospective case-control study performed in Mali. Participants were identified and randomly selected from diabetes registries. We recruited 500 subjects with DM and 500 subjects without DM, matched by sex and age. We conducted structured, personal interviews. Costs were expressed for a 90-day period. Direct medical costs comprised: inpatient stays, ICU, laboratory tests and other hospital visits, specialist and primary care doctor visits, others, traditional practitioners, and medication. Direct non-medical costs comprised travel for treatment and paid caregivers. The indirect costs include the productivity losses by patients and caregivers, and absenteeism. We estimate a two-part model by type of service and a linear multiple regression model for the total cost. We found that total costs of persons with DM were almost 4 times higher than total cost of people without DM. Total costs were $77.08 and $281.92 for ND and DM, respectively, with a difference of $204.84.

Conclusions: Healthcare use and costs were dramatically higher for people with DM than for people with normal glucose tolerance and, in relative terms, much higher than in developed countries.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The research on which this paper is based was organized and funded by International Diabetes Federation (IDF) as part of a program to measure the impact of diabetes in low- and middle-income countries. To fund this program, IDF solicited and combined unrestricted research grants from several commercial pharmaceutical organizations into an Economic Studies Fund. The contributors to this fund were Merck and Co., Novo Nordisk, Eli Lilly and Co., Takeda Pharmaceuticals North America, and GSK, Inc. These contributors did not select the African countries to be studied and had no role in the design, conduct and reporting of the study in any country, including Mali. The manuscript is an honest, accurate, and transparent account of the study being reported, and no important aspects of the study have been omitted. The use of this commercial funding does not alter our adherence to PLOS ONE policies on sharing data and materials. All funders of IDF’s Economic Studies Fund and all participants in the Fund’s projects agreed in writing that study data would be shared publicly. Finally, it was clearly agreed in writing with the sponsors from the start that our studies were independent, that the resulting data would become public, and that scientific decisions would be made without company involvement.

Figures

Fig 1
Fig 1. Flowchart of sample selection process.
Fig 2
Fig 2. Components of cost attributable to DM.
See this image and copyright information in PMC

References

    1. Institute for Health Metrics and Evaluation, Human Development Network, The World Bank. The Global Burden of Disease: Generating Evidence, Guiding Policy—Sub-Saharan Africa Regional Edition. Seattle, WA: IHME, 2013.
    1. Jaffiol C. [The burden of diabetes in Africa: a major public health problem]. Bull Acad Natl Med. 2011. June;195(6):1239–53; discussion 1253–4. - PubMed
    1. International Diabetes Federation. IDF Diabetes Atlas, 7th edn Brussels, Belgium: International Diabetes Federation, 2015. http://www.idf.org/diabetesatlas.
    1. Mohan V, Madan Z, Jha R, Deepa R, Pradeepa R. Diabetes-social and economic perspectives in the new millennium. International journal of diabetes in developing countries 2004, 24:29–35.
    1. World Health Organization. Designing health financing systems to reduce catastrophic health expenditure. Technical briefs for policy makers number 2. (WHO/EIP/HSF/PB/05.02) Geneva: WHO; 2005.