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

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the socio economic burden of diabetes in developing countries lessons from studies in egypt

The Socio-economic Burden of Diabetes in Developing CountriesLessons from studies in Egypt

Professor Morsi Arab

Egypt

slide2

Socioeconomics of Diabetes1- 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 cost7- Government and Household expenditure.8- Cost of O.P. care9-The hospital burden 10- Costs comparative to other countries .

the people with diabetes and their environment
The people with Diabetes and their Environment

IDF

Media

Public . Com.

Diab. Associations

Patient

Friends

Family

Health Care Team

Syndicates

Pharm. Ind.

Health Autho.

WHO

determinants of impact
Determinants of impact
  • 1. High prevalence
  • 2. High cost of disease
  • 3. Low economics
  • 4. Adverse social conditions
age structure of the egyptian population

60

-60

-50

-40

-30

-20

-10

40 30 20 10 0 10 20 30 40

Age structure of the Egyptian population
prevalence of dm
Prevalence of DM

Prevalence (%)

Age range

professor morsi arab university of alexandria egypt

Effect of change of the life style in migrating ethnic groups on metabolic parameters related to diabetesA lesson from the Nubians of Egypt

Professor Morsi Arab

University of Alexandria - Egypt

conclusions
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.

slide23

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%

slide24

Diabetes Complications (Egypt2003) % in Diabetic population Retinopathy : 32.3% Neuropathy : 55.5% Nephropathy : 5.0% Cardiac Dis. : 21.3% Foot ulcers : 6.8% Foot amputations : 3.0% Foot deformities : 1.0%

the cost of diabetes

The cost of Diabetes

Data from Alexandria hospitals

allocation of direct costs in hospital
Medical supplies:

insulin etc.…

Doctors

Lab charges

Basal cost:

Salaries, equipment, food, water, electricity’ laundry etc.

Control of diabetes:

Insulin, OHA, medical supplies

Rx complications:

Antibiotics, laser, haemo- dialysis , surgery etc.

Allocation of Direct Costs in hospital

DIRECT COST

Hospital care

Out-patient

indirect costs
Loss of working hours

Diabetes mortality

Premature death

Indirect Costs

PRODUCTION

the cost of diabetes in egypt
The cost of diabetes in Egypt

Alexandria Hospitals (86/88)

  • O.P. care (per person per year)
    • Doctors’ charges: 35.84 L.E.
    • Medical supplies 30.36 L.E.
    • Laboratory charges 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
The economic burden of direct cost of DM
  • Total direct cost of diabetes in 1986: 160m
  • Average inflation rate (1986-90) 11.85%
  • Estimated total direct cost in 1990 235.2m
  • Total Government expenditure on health, 1990:
    • National production 31.3bn
    • Government expenditure at 40% 12.6bn
    • 2.8% Gov. expenditure on health 351.8m
cost of dm in relation to funds available
DIRECT COST

OF TREATMENT

OF DM

L.E.235.2m

AVAILABLE GOVERNMENT EXPENDITURE ON HEALTH

L.E. 351.8m

Cost of DM in relation to funds available

2/3!!

national economics and reflections on health
National economics and Reflections on health
  • Per capita income
  • %Government expenditure on health
  • % Household consumption

PARAMETERS

slide33

Percentage share of government expenditure

%

N

I

E

S

EE

Health

Education

Defence

slide34

Percentage share of total household consumption

%

N

I

E

S

EE

Medical care

Total food

Education

middle east countries economic status
Kuwait

Emerates

Qatar

Bahrain

Oman

Saudi Arabia

Libya

Israel

Syria

Jordan

Tunisia

Egypt

Turkey

Yemen

Middle East Countries - economic status

HIGH ECONOMY

MIDDLE ECONOMY

LOW ECONOMY

  • Iraq
  • Cyprus
  • Iran

>5,000US$

<2,000US$

slide36
Cost of out-patient ambulatory care of DM in Egypt compared with other Mediterranean countries (US$/month)

*including treatment by dialysis

slide39

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

slide40

Distribution of Hospital Cost

45% Basic

( Food : 5%

H.C.Team 11%

Others: 29%)

55% Medicine & Supp.

slide42

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 )

(B) Oral Antidiabetic Agents

* Heavily subsidized ** moderately subsidized

slide43

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

slide44

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. )
  • Physician fees and other specialist consultations
  • Total 143 USD/Year
  • 76.4
  • 66.6
slide45

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)

* Heavily subsidized ** moderately subsidized

slide47

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.)

slide48

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.)

slide49

Cost Burden of Oral Treatment related to Percapitum

4.2%

29.9%

EGYPT

QATAR

8.4%

SAUDI ARABIA

socio economic impact on diabetes education
Socio-economic impact on diabetes education

-1

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…)
socio economic impact on diabetes education51
Socio-economic impact on diabetes education

-2

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
socio economic impact on diabetes education52
Socio-economic impact on diabetes education

-3

6.Misconceptions & ...

7. Special education programmes

  • e.g for Ramadan fasting

8. Need to tailor diabetes education

  • & arrangements to suit local habits, traditions & lifestyle