Abstract
ABSTRACT
Background and Aims: Global distribution, determinants, and financial aspects of type 2 diabetes mellitus from data in developed countries depict it as a major health problem increasing at an alarming rate. But to the best of my knowledge, a comprehensive study regarding cost burden in developing countries is almost non-existent though it is a similar menace. The present study aimed to investigate and determine the cost of care among patients with diabetes, in the BIRDEM Hospital, the central institute of the Diabetic Association of Bangladesh (DAB), providing diabetes care to a large no of diabetic patients in one centre of the world (total number of registered patients are 0.29 million up to end of 2005).
Materials and Methods: Three hundred uncomplicated diabetes patients registered within two years attending the Out-Patient Department (OPD) were interviewed with a preset questionnaire including scrutinizing guide book records regarding the direct cost (cost of medical advice, investigations, medical treatment), indirect cost [travel cost, cost of productivity loss, and cost of accompanying person(s)] along with an in-depth interview was collected through August-December 2005. A comparison was made between patients undergoing three different treatment modalities (Insulin, oral hypoglycemic agents and lifestyle management). An in-depth interview of the subjects was taken to know the effects of diabetes in life, the value of money they spend for diabetes and responses regarding future.
Results: All T2DM patients in the OPD are taken care of by 78 OPD physicians, 5 Nutrition Officers, 12 social welfare Officers, 6 Health education officers, 128 Health Assistants, and 101 Technicians. Services provided to the patients include medical care, biochemical investigations, nutrition and health education, social welfare support in applicable cases. The total number of visit events in 2004-2005 was 0.04 million. The average cost per patient came to US$ 142 (US$ 88 to patient and US$ 54 to provider). The difference in mean cost of patients with different management groups was found significant (p = 0.000). Lifestyle management is cost sparing to other treatment modalities, and Insulin is costlier to other two. The in-depth interview provided supplementary support to the least cost model.
Conclusion: Findings showed that i) cost of diabetes care is huge even at a reasonable BIRDEM rate ii) cost of treatment with insulin is high and lifestyle management is effective. The study provides a background for policy researchers to advanced studies on economic evaluation. Providing diabetes care to the population is a challenging task particularly in developing countries like Bangladesh. The huge burden despite comprehensive care is only the tip of iceberg and needs resource mobilization and careful health planning.
Key words: Cost; Type 2 diabetes mellitus; Bangladesh