Transcript The Socio-economic Burden of Diabetes in Developing Countries Lessons from studies in Egypt Professor Morsi Arab Egypt.

The Socio-economic Burden of
Diabetes in Developing Countries
Lessons from studies in Egypt
Professor Morsi Arab
Egypt
Socioeconomics of Diabetes
1- The patient and human environment.
2- Patient’s Right and Obligations.
3- Factors deciding the burden of diabetes.
4- Size of the problem : Prevalence
5- Life Style
6- The national cost
7- Government and Household expenditure.
8- Cost of O.P. care
9-The hospital burden
10- Costs comparative to other countries .
The people with Diabetes and their Environment
IDF
Media
Public . Com.
Diab. Associations
Family
Patient
Friends
Health Care Team
Pharm. Ind.
Health Autho.
WHO
Syndicates
Determinants of impact
•
•
•
•
1. High prevalence
2. High cost of disease
3. Low economics
4. Adverse social conditions
CAIRO
Geographical distribution of the
Egyptian population
1%
43%
Urban
Agricultural
Desert
56%
Age structure of the Egyptian population
60
-60
-50
-40
-30
-20
-10
40
30
20
10
0
10
20
30
40
The estimated prevalence with DM
by IDF region, 2000
10
Prevalence (%)
9
8
7
6
5
4
3
2
1
0
AFR
EMME
ER
NA
Region
SACA
SEA
WP
Prevalence of DM in the whole of Egypt
in different age groups
Prevalence (%)
18
16
14
12
10
8
6
4
2
?
0
-10
-20
-30
-40
-50
-60
>60
Prevalence of DM
Prevalence (%)
25
20
15
A
B
C
10
5
0
-20
-30
-40
-50
Age range
-60
>60
Effect of change of the life style in
migrating ethnic groups on metabolic
parameters related to diabetes
A lesson from the Nubians of Egypt
Professor Morsi Arab
University of Alexandria - Egypt
% Prevalence (>40yrs)
Prevalence of DM in patients over 40 yrs
16
14
12
10
8
6
4
2
0
U
UN
RN
RA
RD
Conclusions
1. Changes in life style (diet & exercise( of susceptible
individuals or groups is liable to increase their
predisposition to DM (incidence of transformation of IGT
to DM and consequently increased DM prevalence).
2. The change is more profoundly demonstrated among
groups that might be originally protected by some
genetically inherited characteristics.
3. Most of the parameters of the metabolic syndrome seem
to be closely bound together and are prone to change
under the influence of the adverse changes of life style.
Controlled metabolic parameters
(% in diab. population Egypt 2003 )
- Fasting Bl. Glucose : 19.8%
- P.P Bl. Glucose
: 21.4%
- S. Cholesterol
: 56.4 %
- S. Triglycerides
: 50.4%
- Syst. B.P.
: 53.7%
- Diastolic B.P.
: 64.6%
Diabetes Complications (Egypt 2003)
% in Diabetic population
Retinopathy
Neuropathy
Nephropathy
Cardiac Dis.
Foot ulcers
Foot amputations
Foot deformities
: 32.3%
: 55.5%
: 5.0%
: 21.3%
: 6.8%
: 3.0%
: 1.0%
The cost of Diabetes
Data from Alexandria hospitals
Allocation of Direct Costs in hospital
DIRECT COST
Out-patient
• Medical supplies:
– insulin etc.…
• Doctors
• Lab charges
Hospital care
• Basal cost:
– Salaries, equipment, food,
water, electricity’ laundry etc.
• Control of diabetes:
– Insulin, OHA, medical
supplies
• Rx complications:
– Antibiotics, laser, haemodialysis , surgery etc.
Indirect Costs
• Loss of working hours
PRODUCTION
• Diabetes mortality
• Premature death
The cost of diabetes in Egypt
Alexandria Hospitals (86/88)
• O.P. care (per person per year)
– Doctors’ charges:
– Medical supplies
– Laboratory charges
35.84 L.E.
30.36 L.E.
19.68 L.E.
85.88 L.E. per year
• In-patient hospital care
– Average total cost for one single
admission/year, at average stay:
148.31 L.E. per year
The economic burden of direct cost of DM
• Total direct cost of diabetes in 1986:
• Average inflation rate (1986-90)
• Estimated total direct cost in 1990
160m
11.85%
235.2m
• Total Government expenditure on health, 1990:
– National production
– Government expenditure at 40%
– 2.8% Gov. expenditure on health
31.3bn
12.6bn
351.8m
Cost of DM in relation to funds available
DIRECT COST
OF TREATMENT
OF DM
AVAILABLE
GOVERNMENT
EXPENDITURE ON
HEALTH
L.E.235.2m
L.E. 351.8m
2/3!!
National economics and
Reflections on health
PARAMETERS
• Per capita income
• %Government expenditure on health
• % Household consumption
Gross National Product/Capita
N
I
E
S
EE
20
18
16
14
12
10
8
6
4
2
0
18 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19
Percentage share of government expenditure
N
I
E
S
EE
60
50
40
30
20
10
0
18 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19
Health
Education
Defence
Percentage share of total household consumption
N
I
E
S
EE
70
60
50
40
30
20
10
0
18 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19
Medical care
Total food
Education
Middle East Countries - economic status
HIGH ECONOMY
MIDDLE ECONOMY
• Kuwait
•
•
•
•
•
•
•
Emerates
Qatar
Bahrain
Oman
Saudi Arabia
Libya
Israel
>5,000US$
• Iraq
• Cyprus
• Iran
LOW ECONOMY
• Syria
• Jordan
• Tunisia
• Egypt
• Turkey
• Yemen
<2,000US$
Cost of out-patient ambulatory care of DM in Egypt
compared with other Mediterranean countries (US$/month)
MEDICINES
Insulin
Alex (Egypt)
2.44
Oral
Self
Monitor TOTAL
1.12 2.49
6.06
Treat
Compl.
2.28
TOTAL
O.P.Tr.
8.34
29.94* 35*
Tunisia (Tunis)
12.24 2.85 3.23
Oran (Algeria)
23.14 9.87 15.45 27.54 71.08
98.62
Zagreb
23.56 2.54 15.34 24.16 7.44
31.60
Athens (Greece)
38.48 7.53 15.35 39.15 71.45
110.60
Pavia (Italy)
27.38 3.33 5.52
37.75
6.69
4.17
12.65 25.1
10.86
*including treatment by dialysis
Socio-economics - Some health and
education parameters in 20 African countries
Country
1. Mozambique
2. Tanzania
3. Ethiopia
4. Somalia
5. Uganda
6. Nigeria
7. Kenya
8. Ghana
9. Central Africa
10. Zambia
11. Sudan
12. Egypt
13. Senegal
14. Morocco
15. Cameroon
16. Congo
17. Tunisia
18. Algeria
19. Gabon
20. Libya
MEAN (AFRICA)
MEAN (UK, USA &
FRANCE)
Per Capita
income (US $)
Life Expectancy
(Years)
Adult
Illiteracy (%)
80
110
120
120
220
290
370
390
390
420
…….
610
710
950
960
1010
1440
2060
3330
5637
1,011
19,127
47
48
48
48
65
61
59
49
49
50
50
60
47
62
57
53
67
65
53
62
54.5
76.6
67
76
52
49
31
40
62
27
73
52
62
51
46
43
35
43
39
36
49
<5
Total Cal. food
consumption
/cap/day
1680
2206
1735
1906
2153
2312
2189
2240
2036
2019
1974
3327
2440
3320
2201
2604
3080
2989
2248
3324
2296
3443
Socio-economics Increasing total calorific intake
Years
1970
Subsaharan
Africa
2138
North Africa &
Middle East
2415
1975
2118
2586
1980
2120
2875
1985
2155
2984
1990
2099
3094
Distribution of costs of Hospital Treatment of
Diabetic Patients ( L.E. per day ) at a Private Hospital
for Middle Class Egyptian Population at the City of
Alexandria , Egypt 2001
Cost of Medications and Medical
supplies
Basic hospital expenses
- Food
- Health Care Team
- All other running expenses
Average total cost per day
L.E.
%
99.00
55 %
9.00
19.80
52.20
5%
11 %
29 %
180 L.E. (= 40 $ )
100 %
Distribution of Hospital Cost
55%
Medicine
& Supp.
45%
Basic
( Food : 5%
H.C.Team 11%
Others: 29%)
Hospital Treatment 2001 Cost /Day
400%
354%
350%
346%
300%
250%
200%
150%
100%
100%
120.80%
50%
0%
DM
+CVD
+R.F.
+Diab. Foot
Estimated Costs of Ambulatory (out patient)
Treatment of Diabetes in Egypt at 2001
Cost Prices in USD/ year
(A) Insulin ( Dose 10-80 units /d )
Type of Insulin
Cost in USD/y
3.6 – 29.2
14.6 – 116.8
32.8 – 262.8
54.7 – 438.0
Animal I U/40 *
Human I U/40 **
Human I U/100
Human I in pen device U/100
(B) Oral Antidiabetic Agents
Type of oral antidiabetic Agents
Glibenclamide
Gliclazide
Glimepride
Metformin
Rapiglinide
Nateglinide
Rosiglitazone
* Heavily subsidized
Daily dose
Cost in
USD/y
5 mg - 20 mg
80 mg - 240 mg
1 mg 6 mg
500 mg- 1500 mg
3 mg
360 mg
4 mg
14.0- 56.0
27.0- 81.0
32.0-162.0
10.0- 30.0
- 235
- 405
- 446
** moderately subsidized
Cost of O.P. Treatment (Egypt 2001) $/ y
Animal u/40
Human u/40
Human u/100
Human/pen
Metformin
Glibenclam
Gliclazide
Glimeperide
Rapiglinide
Nateglinide
Rosiglitazone
0
1
2
3
4
5
Hundreds
Estimated Costs of Ambulatory (out patient)
Treatment of Diabetes in Egypt at 2001
Cost Prices in USD/ year ( Cont.)
( C ) Other costs at average frequencies per year
Laboratory , and other follow – up
investigations (E.C.G radiol., etc. )
76.4
Physician fees and other specialist
consultations
Total
66.6
143 USD/Year
The Burden of the Cost of Ambulatory Treatment of
Diabetes on Individuals at Low-Income and High-Income
Middle East Countries, based on the Cost Prices of
Insulins and Oral Antidiabetic Agents (in USD per year)
Egypt
Morocco
Qatar
Saudi
Arabia
Percapit. Income in
USD
1490
1180
13730
6900
Animal Insulin U/40
(40 units /d)
14.6 *
134.3
NA
NA
Human Insulin U/40
(40 units /d)
55.5 **
313.9
NA
NA
Human Insulin
U/100 (40 units/d)
132.9
318.3
258.4
213.0
Human Insulin in
Device U/100 (40
units/d)
219.0
446.7
-------
-------
* Heavily subsidized
** moderately subsidized
Year Cost / percapit. Burden for Human Insulin (40 u /d)
8.85%
EGYPT
1.9%
QATAR
3.1%
SAUDI ARABIA
The Burden of the Cost of Ambulatory Treatment of Diabetes
on Individuals at Low-Income and High-Income Middle East
Countries , based on the Cost Prices of Insulins and Oral
Antidiabetic Agents ( in USD per year) (Cont.)
Egypt
Morocco
Qatar
Saudi Arabia
Percapit. Income
in USD
1490
1180
13730
6900
Glibenclamide
(5-20 mg)
14-56
41-164
94-376
Cliclazide
(80-240 mg)
27-81
48-144
98-294
Glimeperide
( 1-6 mg )
32-162
57-292
-------
Metformin
(100-1500 mg)
20-30
24-36
44-66
The Burden of the Cost of Ambulatory Treatment of Diabetes
on Individuals at Low-Income and High-Income Middle East
Countries , based on the Cost Prices of Insulins and Oral
Antidiabetic Agents (in USD per year) (Cont.)
Saudi Arabia
Egypt
Morocco
Qatar
Percapit.
Income in
USD
1490
1180
13730
6900
Rapiglinide
( 3mg)
235
------
------
243
Nateglinide
(360 mg )
405
------
------
------
Rosiglitazine
( 4 mg )
446
------
------
584
Cost Burden of Oral Treatment related to Percapitum
4.2%
29.9%
EGYPT
QATAR
8.4%
SAUDI ARABIA
Socio-economic impact on diabetes education
1. Lower economy;
– less available resources for education
2. Lack of rational plan for:
– patient education
– physician education
– other health personnel (nurses,dieticians,foot care
etc…)
– general public (awareness: food intake, obesity,
exercise, early detection etc…)
-1
Socio-economic impact on diabetes education
3. Lack of government awareness
– of cost/benefit of education
4. Maldistribution
– of available education facilities (urban/rural)
5. High illiteracy
– adversely affects diabetes education & requires
special methods
-2
Socio-economic impact on diabetes education
6. Misconceptions & ...
7. Special education programmes
– e.g for Ramadan fasting
8. Need to tailor diabetes education
– & arrangements to suit local habits, traditions &
lifestyle
-3
Alexandrie – Palais du Montazah
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