Projections to 2025
New estimates for 2007 and 2025
In 2003, the second edition of the Diabetes Atlas presented the first worldwide Tables of country-specific estimates of expenditures for health and medical care caused by diabetes. These estimates were generated using a formula that combines estimates of total national health spending, the prevalence of diabetes by country, and the ratio of diabetic to non-diabetic medical care expenses (‘R’) .
For this edition of the Atlas, a more complex version of this formula was used. Instead of relying on one value for R and one value for countrywide per capita health expenditures, the expanded formula used different values for each of 42 different subgroups, according to age and sex within each country. Expenditure estimates nearly doubled using the more precise formula. Details and critiques of the formula and data are found in Methodology .
How to read the Tables of health expenditures
Table 5.1 provides a summary of the global health expenditure in the years 2007 and 2025. Table 5.2 summarizes the new estimates by region, age and sex. Tables 5.3 - 5.9 display total estimated national health expenditures caused by diabetes for 193 countries in the years 2007 and 2025. For 2007, these Tables also show the estimated per person expenditure for diabetes for each person with diabetes. These are not total expenditures per person with diabetes; they are only the expenditures caused by diabetes. They include expenditures for public health programmes as well payments for medical care (see Methodology).
Estimates are shown in both United States dollars (USD) and international dollars (ID). US dollars are best used to compare currency prices or expenditures for diabetes care. International dollars are corrected for differences in prices among countries. Estimates in ID are best used to compare the amount of diabetes care that countries produce. Amounts in both USD and ID are expressed as of their value in 2002, the most recent year for which national health expenditure estimates have been published 1 .
Estimates are shown at two values of the diabetes expenditure ratio, R. R is the ratio of medical care expenditures for persons with diabetes to age- and sex-matched persons without diabetes. R is the key parameter in the conversion of per capita health spending into estimates of spending caused by diabetes. Based on current evidence, which is very limited, we think that R rarely falls below 2.0 in any country and rarely exceeds 3.0. In the industrialized countries of North America, Europe and the Western Pacific, R has probably been falling and a value closer to 2.0 should be assumed 2 . In other countries, it is impossible as yet to recommend a ratio (see Methodology for details).
Comparisons to other estimates
Despite the many difficulties that accompany international comparisons of economic studies 3 , the estimates presented here are largely confirmed by independent estimates obtained from industrialized countries where direct studies of diabetes expenditures have been conducted. Because there are the countries in which the great bulk of medical care spending for diabetes occurs, these studies also suggest that, at R=2, the estimates presented here of global health expenditures for diabetes are roughly accurate. For example, a recently published study of the expenditure burden of diabetes in Germany in 2001 (CoDiM) reported net per capita expenditures of EUR2,507, quite similar to the estimate here of USD2,713 in 2002 dollars (R=2) 4 . CoDiM also observed an overall R for direct medical care of 2.0.
Earlier, the CODE-2 Study estimated annual per capita type 2 diabetes expenditures at EUR2,834 in Western Europe in 1999. CODE-2 estimated expenditures that ranged from EUR1,305 +/-2,197 in Spain to EUR3,576 +/-920 in Germany 5 . For Spain, IDF’s formula-based per capita estimate for 2007 (in 2002 USD) is very similar: USD1,276, assuming R=2. (In 1999 and 2002, the exchange rate between euros and US dollars was approximately 1.0.)
In Australia, the DiabCo$t Study 6 estimated a direct medical care expenditure per person with diabetes (including expenditures for treating both diabetes and other health conditions) of AUD4,260 (in 2001 AUD). This equals approximately USD2,179 at mid-2001 exchange rates, similar to IDF’s formula-based estimate for 2007 of USD2,369 in 2002 dollars. However, the IDF estimate omits expenditures not caused by diabetes, so these estimates do not confirm each other.
The American Diabetes Association’s most recent estimate expenditures for medical care for diabetes over all age groups in the USA is USD91.8 billion in 2002 (USD 5,642 per person) 7 . The IDF formula-based estimate for the USA in 2007 is somewhat higher, USD119.4 billion (USD6,537 per person) at R=2. However, the IDF per capita estimate includes more diabetes-caused medical care than the ADA’s study was able to capture, and includes more health expenditures than those used for medical care. Some of these additional expenditures, such as payments for medical research, are substantial in the US. For a more precise comparison, the ADA’s aggregate estimate also should be adjusted to account for undiagnosed diabetes and for the increase in US diabetes prevalence since 2002.
Published studies of expenditures for diabetes are nearly all from developed countries. Therefore, confirmation of estimates for developing countries remains uncertain. The IDF per capita estimate appears similar to a recently published estimate for the publicly supported medical care systems in Mexico, after removing indirect costs and adjusting for inflation 8 .
In China, a 2002 study of patients of endocrinologists from 11 different provincial capitals, including Beijing and Shanghai, estimated that patients with type 2 diabetes without diabetic complications consumed USD450 per year in direct medical expenditures, while patients with both microvascular and macrovascular complications consumed USD4,665 9 . IDF’s countrywide estimate for China based on formula is much lower, USD89 and ID351 per person, but it encompasses nearly a billion rural Chinese who have no health insurance, and tens of millions of urban residents who cannot afford treatment by the endocrine specialists who contributed the Chinese data. Similarly, IDF’s countrywide estimate for India (USD47 per person a year) is somewhat lower than a report from Madras, a large city in southern India 10 .
1.World Health Organization The World Health Report 2002. Geneva, Switzerland: World Health Organization; 2003
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5.Jonsson,B. Revealing the cost of Type II diabetes in Europe. Diabetologia.2002;45(7): S5-12
6.Colagiuri,S. Colagiuri,R. Conway,B. Grainger,D. Davey,P. DiabCost Australia: Assessing the Burden of Yype 2 Diabetes in Australia. Canberra: Diabetes Australia.2003
7.American Diabetes Association. Economic costs of diabetes in the U.S in 2002. Diabetes Care.2003;26(3):917-932
8.Arredondo,A. Zuniga,A. Parada,I. Health care costs and financial costs of epidemiological changes in Latin America: evidence from Mexico. Public Health.2005; 119:711-720
9.Chen,X. Tank,L. Tan,A. Zhao,L. Hu,C. Economic Burden of the Impact od Complications of Type 2 Diabetes Mellitus in Urban China. Unpublished
10.Shobhana,R. Rama,R.P. Lavanya,A. Williams,R. Vijay,V. Ramachandran,A. Exenditures on health care incurred by diabetic subjects in a developing country - a study from southern India. Diabetes Res Clin Pract.2000;48(1): 37-42