With rising costs of Diabetes predicted to reach the 1000 billion mark (in Rupees), diabetologists stress the urgent need for policy makers to allocate resources for strategies to prevent diabetes and manage its complications.
Extrapolating direct and indirect estimates to the Indian population, based on a survey, it was predicted that the annual costs (both direct and indirect) for diabetes in 2010 would be Rs.1,541 billion. A paper published in the recent issue of Diabetes Research and Clinical Practice by Shabana Tharkar, Arutselvi Devarajan, Satyavani Kumpatla and Vijay Vishwanathan argues that policy level changes that would have an impact on finances allocated for fighting diabetes are the order of the day.
An earlier WHO estimate predicted that India will lose $237 billion, in national income due to diabetes, stroke and heart disease in the next decade.
A total of 4,677 subjects were screened, and 718 participated in the survey. The authors estimated the average expense based on calculations of direct and indirect costs incurred by the participants. Direct costs (that form 83.7 per cent of the total costs) were defined as the costs of medical care in relation to diagnosis and treatment of diabetes and its complications. “Of all the cost components, this is the least controversial measurement and easily assessable measure,” says Dr. Vijay.
Indirect costs are loss of income from workday lost due to absenteeism related to the disease. The total direct cost per annum was estimated to be Rs.25,391; of which hospitalisation was the highest contributor at Rs.12,992. This was followed by the spending for drugs and monitoring diabetes – Rs.8,595. The total cost is also inclusive of Rs.2,932 for outpatient visits.
The study showed that patients who did not have any complications spent Rs.6,520 on care, while those with complications had an escalated expense of Rs.32,500. The annual indirect cost was estimated to be around Rs.4,970. Simultaneously, the increased hospital admission rates and increased duration of diabetes had an effect on increasing the costs.
Dr. Vijay explains that diabetes patients with poor glycaemic control had indirect costs three times higher than those with good control, stemming from more losses in productivity and income.
It is no secret that India is among the nations with the highest per capita out-of-pocket spending on healthcare. This study established that the expenditure of patients for treatment and management of diabetes in India was met mostly through the personal savings account (60 per cent). About 39 per cent of patients paid with money culled from selling or mortgaging property and borrowing loans at high rates of interest.
Further, Dr. Vijay adds that the economic costs of undiagnosed diabetes are beyond the scope of the study, and may underestimate the results.
In 2008, an article in Globalisation and Health by Karen Siegel and KM Venkat Narayan made a strong case for investment into prevention of diabetes: “A failure to invest now in health will be disastrous for countries when today's children become the next generation of workers. As emerging market countries integrate into the global economy, the health and vitality of their workforce is imperative.”
Tamil Nadu's Principal Secretary, Health, V.K. Subburaj, said the State now has a robust programme to prevent non-communicable diseases, including diabetes. The State spends about Rs.50 crore for diagnosis and treatment (inclusive of free insulin) of diabetes under various schemes, he added.