A study of the economic costs of diabetes mellitus in tanzania in 1989/90

Abstract

To estimate the direct and indirect costs of diagnosis, treatment, complications and follow up of diabetic patients in Tanzania. Diabetes costs estimated from the data and reported experience of diabetic patients first seen at the diabetes clinic at Muhimbili Medical Centre, Dar es Salaam in 1981/82 and patients with newly diagnosed diabetes seen in 1989/90. Muhimbili Medical Centre, Dar es Salaam, Tanzania. 464 patients: 315 men, 149 women. All 202 patients diagnosed to have diabetes between 1 June 1981 and 31 August 1982 (Group I). All 262 patients diagnosed between 1 September 1989 and 31 October, 1990 (Group II). The average direct cost of diagnosis per person was Tshs. 2212 (US $ 11). The average one year direct cost of diabetes care in 1989 - 90 was Tshs 57365 (US $ 287) for a patient with insulin-requiring diabetes mellitus (IRDM) and Tshs 20553 (US $ 103) for a patient with non-insulin dependent diabetes mellitus (NIDDM). Outpatient costs accounted for 79.8% of the total direct cost in an IRDM patient while the corresponding figure for an NIDDM patient was 67.2%. For an IRDM patient insulin purchase accounted for 68.2% of the average one year direct outpatient costs, and treatment of chronic complications and infections accounted for 13.2%. For an NIDDM patient, of the total one year direct outpatient costs, purchase of oral hypoglycaemic drugs was 42.5% and treatment of chronic complications and infections was 48.8%. Indirect costs were calculated in terms of Healthy Life Days (HLDs) lost because of diabetes mellitus. It was found that total future healthy life days lost per patient were 4100 days. Of these 69% were lost because of premature mortality, 1% was lost due to disability before death, 29% because of chronic disability and 1% due to infections and acute complications associated with diabetes.

Vii For outpatient care of all diabetic patients 15 years and above in Tanzania in 1989 - 90 about US $ 2,721,151 were needed. The outpatient costs were distributed as follows: 30.8% for treatment of infections and chronic complications of diabetes, 32.2% for insulin purchase, 24.3% for oral hypoglycaemic drugs, 3.5% for self home care urine glucose strips, 5.9% for self care syringes, needles, spirit and cotton swabs, 1.9% for clinic urine and blood glucose tests and 1.2% for transport costs. Doctors' and nurses' costs accounted for 0.2% of the total one year outpatient care costs. The total direct inpatient care costs for all diabetic patients 15 years and above in Tanzania in 1989 - 90 were estimated to be US $ 1,255,312 The inpatient costs were distributed as follows: investigations 40.4%, meal and bed 22.0%, insulin 5.9%, antibiotics 3.7%, intravenous fluids 4.5%,syringes and needles 5.1 %, oral hypoglycaemic drugs 0.5%, antihypertensives 1.4%, other inpatient treatment costs 4.8%. Nursing and doctors' costs accounted for 9.1 % and 2.5% respectively of the total inpatient costs. To have cared for all diabetic patients 15 years and above in Tanzania in the year 1989/90 about Tshs. 795,292,530 (US $ 3,976,463) would therefore have been required. Of the total direct costs, 68% was for outpatient care and 32% for inpatient care. Excluding costs for transport (born by the patients themselves) and self home blood or urine glucose monitoring (not presently done) from the total direct costs of diabetes care, then the actual government exp€nditure on diabetes care in 1989/90 was Tshs. 769,713,714 (US $ 3,848,569). This implies that 0.2% (diabetic patients who were on treatment) of the Tanzanian population 15 years and above used about 8.1% of the total government health expenditure which was Tshs. 9,481,676,460 (US $ 47,408,382) Financial requirements for the care of diabetic patients in Tanzania are therefore extensive, and place a very great burden on the limited government resources available for health care. This study highlights the increasing strain which the care of patients with chronic diseases will place on the health budgets of developing countries and the need for exploring alternative methods of health ca