Estimating cost of illness of diabetes mellitus in out-patient clinic setting of Karachi, Pakistan

Diabetes is becoming one of the major public health problems because of its rapid rise and a great proportion of the health care expenditure has been spent on the treatment of its associated morbidity and mortality. In every 10 seconds two people develop the disease and in same 10 seconds one person dies of diabetes related causes. Once diabetes develops, it is a costly disease to manage because of its chronic nature and severity of its complications. Chronic complications of diabetes include both macrovascular and microvascular complications. Managing diabetes alone can be costly and the costs associated with complications are far greater. Besides financial loss the human, social and economic costs of diabetes are also enormous. Cost analysis studies are scanty in developing countries including Pakistan. Thus we embarked with a study to estimate the direct and indirect cost of illness attributable to diabetes mellitus among attendees of out-patient clinics in Karachi, Pakistan. A pre-tested questionnaire was used to collect the data from total 345 persons with diabetes. Data was collected about their socio-demographic & clinical characteristics and cost of diabetes including consultation, investigations, medicine, travel, food and other costs. Indirect cost was calculated by using human capital approach. Cost for subsidized services was imputed using the average approximate of respective service. Minimum wage rates were used to calculate the income of housewives who were actively involved in home chores. Collected data was almost right skewed, therefore nonparametric tests were applied. We found that mean (SD) direct cost borne by person with diabetes and/ or his family is estimated to Rs. 1,930/- [SD 1385.318] for each visit. After adjustments, the monthly mean direct cost was Rs. 965. The mean (SD) indirect cost of patients and their attendants is estimated to Rs. [112.59 (284.91)] and [207.65 (497.91)] respectively. Hence, the total mean economic cost was Rs. 1,035/- per month. In this study, increasing age and number of complications due to diabetes elevate the burden of cost on society. From the total diabetes cost components cost for medicine takes the largest share (46%), followed by laboratory cost (32%). This study has underestimated the actual cost of diabetes care by excluding the hospitalization cost and other important economic indirect costs. Nevertheless, the derived cost is mind blowing and threatens to stunt economic growth and undermines the standard of living. The overall cost can be reduced by prevention of diabetes, earlier detection of disease and reduced diabetes co-morbidities and complications through improved diabetes care. Health care prevention and education are helpful tools to fight against diabetes. Prevention programs need to be initiated at larger scale to enhance health gain to the individual. People may be educated to adopt healthy lifestyle (alter diet, increase physical activity etc.) to reverse the advance of this epidemic. These prevention programs are extremely important for high risk population