The costs of diabetes treatment in low- and middle-income countries: a systematic review

Abstract

Introduction: The rising burden of diabetes in low- and middle-income countries may cause financial strain on individuals and health systems. This paper presents a systematic review of direct medical costs for diabetes (types 1 and 2) in low- and middle-income countries.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases (PubMed, International Bibliography of Social Science, EconLit) were searched for publications reporting direct medical costs of type 1 and 2 diabetes. Data were extracted from all peer-reviewed papers meeting inclusion criteria, and were standardised into per-patient-visit, per-patient-year and/or per-complication-case costs (2016 US$).

Results: The search yielded 584 abstracts, and 52 publications were included in the analysis. Most articles were from Asia and Latin America, and most focused on type 2 diabetes. Per-visit outpatient costs ranged from under $5 to over $40 (median: $7); annual inpatient costs ranged from approximately $10 to over $1000 (median: $290); annual laboratory costs ranged from under $5 to over $100 (median: $25); and annual medication costs ranged from $15 to over $500 (median: $177), with particularly wide variation found for insulin. Care for complications was generally high-cost, but varied widely across countries and complication types.

Conclusion: This review identified substantial variation in diabetes treatment costs; some heterogeneity could be mitigated through improved methods for collecting, analysing and reporting data. Diabetes is a costly disease to manage in low- and middle-income countriesand should be a priority for the global health community seeking to achieve Universal Health Coverage.

Keywords: diabetes; health economics.

Figure 1

Flow of abstract and article selection. Note: Articles could be excluded from review for more than one reason.

Figure 2

Year of publication for included publications. There were also two articles from 2017 (published subsequent to the search) which were added following author instructions but did not result from the search and so are not presented here.

Figure 3

Geographic source of data for included publications. ECA, Europe/Central Asia region; LAC, Latin America/Caribbean region; MENA, Middle East/North Africa region; SSA, sub-Saharan Africa region.

Figure 4

Per-patient annual costs of diabetes care components (among articles reporting on these components). Note: Articles are organised first within data collection-type groups; and within each of these, in ascending order of per-capita gross domestic product.

Figure 5

Per-visit outpatient visit costs of diabetes (among articles reporting on this). Note: Articles are organised first within data collection-type groups; and within each of these, in ascending order of per-capita gross domestic product. Outpatient visit costs include provider and consultation fees, as applicable.