My research question is: What is the global economic burden of diabetes?
Diabetes is a very important chronic condition with a global prevalence of almost 9%.
[It has] increased over the past few years, became more important, for different reasons.
One is a change in lifestyle, different nutrition all over the world, but also demographic change,
populations getting older. And diabetes has several consequences.
[These] can be rather minor reductions in the quality of life but can also be rather major, leading, for instance,
to the amputation of the diabetic foot
and therefore severely reducing the ability of a person to participate in the labor force.
The cost of diabetes consists of two parts, one, the direct part, which includes medical expenditure for drugs
but also the medical care for the amputation for instance.
And the indirect part, which is the loss in productivity, the drop out of the labor force and absent days from work,
or premature mortality. And, in this light, the question is: what is the global economic burden of diabetes?
To calculate the economic burden of diabetes, there are two parts.
One part is the direct cost and one part is the indirect cost. Let me start with the direct cost.
For the direct cost, in an ideal world, we would just sum up the diabetes specific expenditure, for the drugs
or for the other treatment. Unfortunately, such data does not exist. Therefore, a second best approach is used.
Before, a study of the status quo was done by the International Diabetes Federation,
where they took cost ratios of diabetics relative to non-diabetics from the United States,
and multiplied health expenditure in all countries with these cost ratios,
thereby assuming that the diabetes expenditure in high income countries
and low income countries all follow the same pattern as in the United States.
The contribution of our study was that we calculated these cost ratios for different regions of the world
and no longer assigned the United States cost ratio, for instance, to India.
Otherwise, we followed the same approach but just enriching the basis upon which it was implemented.
For the indirect cost, the methodological approach was a systematic review
and in this systematic review our team investigated many,
many studies that estimated the effect of diabetes on productivity, on missed days at work,
on drop out from the labor force, and also, on mortality.
Then, in a so called meta-analysis, the effects of these different studies were put together,
a second aggregate effect.
And also this was done for different world regions,
taking into account that the effect of diabetes on productivity in Germany will likely be very different from India
or other low and middle income countries due to differences in quality of care.
Our key findings are that the economic burden of diabetes is quite substantial.
The total amount is 1.3 trillion US dollars, which is equivalent to almost 2% of global GDP.
Around 35% of the economic burden comes from the indirect costs, so the labor market losses.
Of course, it varies a little bit between countries. In some regions, the indirect cost is higher than in others.
Another key insight is that the economic burden is not only high in the rich countries but also in low
and middle income countries.
The United States, North America, is by far the region with the highest economic burden but we also observed [a]
high and important economic burden in sub-Saharan Africa and in regions such as South Asia.
Another key insight is the composition of indirect cost.
The indirect cost is mostly driven by dropouts from the labor force and premature mortality – [the]
global average is roughly fifty-fifty between the two and smaller shares for missed work days and productivity losses.
When you compare high and low income countries,
the indirect costs in low income countries are driven almost entirely (90%)
by premature mortality whereas in high income countries,
they’re driven mostly by labor force dropouts which comprise almost two thirds of the indirect costs in high income
countries.
The findings are relevant because they allow policymakers to understand what the economic consequences of diabetes are
and, arguably, there's a tradeoff between direct and indirect cost.
With some investment in prevention of diabetes,
it might be possible to avoid that a person drops out of the labor force.
Learning more about the exact numbers and these tradeoffs is very important for policymakers.
In some companion studies that I do with colleagues here from Göttingen and from Heidelberg and Harvard,
we look at health systems’ performance for diabetes and other chronic conditions
and in this collaboration we use a unique dataset where we have blood measures from people so we exactly know who has
diabetes and who doesn't.
And people are asked if they have ever [been] diagnosed before this study, if they're aware of the diagnosis,
if they've received any counseling or treatment, and, if the disease is under control.
And the quite shocking result is, of the people that have diabetes,
roughly one third has never been tested for diabetes before and, out of these, a few were not aware of the diagnosis
and very many have not received any treatment.
And this is, to some extent, driving the economic burden because diabetes is a disease that can be treated
and if it's not detected then it will potentially lead faster to more severe complications
and has more severe consequences for the labor market
and our findings will allow policy makers to address this in a better way.
One insight from our study is that diabetes is also a problem in low and middle income countries
and causing a severe economic burden there. This is something that needs to be on the global health agenda.
One recommendation is to take diabetes and other chronic conditions seriously
and to invest in health systems that are able to detect the condition in people at an early stage
and treat them in a good way.
What we would support
and recommend is that the problems are detected at such an early stage that preventive measures
and very soft measures can help to overcome the problem.
In a follow up study, we made projections of the economic burden of diabetes for the year 2030.
Projection, not in the sense that we are predicting what will happen, projections, in the sense that,
for certain “what if” scenarios, we calculate what the economic burden will look like.
We modeled three different scenarios.
One scenario is that things will stay as they are
and the only thing that changes is the demographic structure of the population and urbanization of the population.
That’s something that is very easy to predict.
The second scenario is that in addition to demographic structure and urbanization, past trends will continue.
So past trends in the increase of diabetes prevalence will continue.
And the third scenario is that the goals of the international community,
set out for instance in the sustainable development goals, will be met,
meaning that the prevalence of diabetes will go down substantially.
The finding of our study is that even in the most optimistic scenario,
which is the scenario that the global goals from the sustainable development goals are met,
the economic burden of diabetes will still increase.
In future studies, we plan to investigate the performance of health systems.
So how can health systems improve to earlier detect cases of diabetes,
to better deliver preventive measures to the patients and to better control the disease?
This will be done at the national, at the health systems level,
but then also our collaboration will implement interventions in different settings, in my case, India,
but also in sub-Saharan Africa, and investigate to what extent these interventions can improve the treatment
and the prevention of diabetes.
