Abdesslam Boutayeb, Faculty of Sciences, University Mohamed Ier, Oujda, Morocco
28 September 2012
In this paper published by Kirigia et al.(1), the authors have interestingly estimated the economic burden of diabetes mellitus in the 46 countries of the WHO African region. The economic burden analysis was carried out for three groups of countries, namely a first group of six countries with gross national income (GNI) per capita greater than 8000 international dollars(Int$), a second group of six countries with GNI between 2000 Int$ and 7999 Int$, and finally a third group of 33 countries with GNI less than 2000 Int$. GNI for Zimbabwe was missing.
Following Barcelo et al.(2), the authors used standard cost-of-illness methods to evaluate:
(1) The direct cost borne by the health systems and the families
(2) The indirect costs through losses of productivity due to premature mortality, permanent disability and temporary disability caused by diabetes.
The economic cost of diabetes was estimated on the basis of the average prevalence of diabetes in each group with the followings assumptions:
(a) The number of people with Type 2 diabetes represents 90% of the total number of diabetes patients and the remaining 10% were supposed to have Type 1 diabetes (page 1 of appendix, (A) Population )
(b) The total number of people in need of insulin (NI) is equal to all the Type 1 diabetes patients ( 97400, 53600 and 551000 in group 1, 2 and 3 respectively) plus 5% of the Type 2 patients (48700, 26800 and 275500 in group 1, 2 and 3 respectively) ( page 3 of appendix, (F) Insulin )
(c) The total number using syringes is equal to NI as defined in (b)
( page 4 of appendix, (G) Syringes )
(d) The number of people using reagent strips is equal to NI (defined in (b))
( page 4 of appendix, (H) Reagent strips )
(e) The number of people using glucose meters is equal to NI (defined in (b)) ( page 4 of appendix, (I) Glucose meters )
(f) The number of patients hospitalized is equal to NI as defined in (b) (page 4 of appendix, (L) Cost of Hospitalizations)
The efforts devoted by the authors to carry out this interesting study are praiseworthy. However, I would like to address the following comments:
C1) For people needing insulin, the numbers computed for the 5% of people with Type 2 diabetes are overestimated. In fact the numbers used by the authors represent (wrongly) 5% of the total numbers of diabetes patients:
(48700 = 5%*974000; 26800 = 5%*536000 and 275500 = 5%*5510000).
Consequently, the total number in need of insulin in group 1, 2 and 3 should be respectively 141200, 77700 and 798950 instead of NI1=146100, NI2=80400 and NI3=826500 used by the authors.
C2) The same ¿wrong¿ numbers NI1 , NI2 and NI3 are used to estimate:
(G) The cost of Syringes, (H) the cost of reagent strips, (I) the cost of glucose meters, and (L) the cost of Hospitalizations.
C3) In page 3, the authors explain how the Mauritanian Lipid test cost of Int$28.9 was obtained but in page 6 of appendix, the value of Int$29 for lipid profile is used in group1 while Mauritania belongs to Group3.
C4) More importantly, the authors assumed that only people using insulin (Type 1 + 5% of Type 2) were using reagent strips and glucose meters. This assumption is controversial because the vast majority of the literature on diabetes (3-6) recommends that people with Type 2 diabetes on insulin and/or tablets should regularly control their blood glucose, while the authors have considered only one HBA test per year.
C5) Similarly, the authors assumed that only people using insulin (Type 1 + 5% of Type 2) were facing hospitalization. This may be true in the case of hypoglycemic coma but in general, diabetes patients not using insulin are also susceptible to need hospitalizations especially with age and bad control.
REFRERENCES:
1. Kirigia JM, SamboHB, Sambo LG and Barry SP. Economic burden of diabetes mellitus in the WHO African region. BMC International Health and Human Rights 2009, 9:6
2. Barcelo A, Aedo C, Rajpathak S, Robles S: The cost of diabetes in Latin America and the Caribbean. Bulletin of the World Health Organization 2003, 81:19-27.
3. IFD. IFD Diabetes Atlas. 15th edition, International Diabetes Federation, Brussels, 2011
4. UKPDS (U.K. Prospective Diabetes Study) Group. 1998. ¿Intensive Blood-Glucose Control with Sulphonylureas or Insulin Compared with Conventional Treatment and Risk of Complications in Patients with Type 2 Diabetes (UKPDS 33).¿ Lancet 1998, 352 (9131): 837¿53
5. Venkat KM, Zhang NP, Kanaya AM, Williams DE, Engelgau MM, Imperatore G ,and Ramachandran A. Diabetes: The Pandemic and Potential Solutions. In Disease Control Priorities in Developing Countries, chapter 30. Jamison DT et al editors. Washington (DC): World Bank 2006
6. Bjo¨rk S. The cost of diabetes and diabetes care. Diabetes Research and Clinical Practice. 2001, 54 , suppl 1: S13-S18
7. Boutayeb A, Boutayeb S. The burden on Non Communicable Diseases in developing countries. Int J Equity Health; 2005:4(1):2
Competing interests
The author declares that He has no competing interests
Discussion of estimation parameters
28 September 2012
In this paper published by Kirigia et al.(1), the authors have interestingly estimated the economic burden of diabetes mellitus in the 46 countries of the WHO African region. The economic burden analysis was carried out for three groups of countries, namely a first group of six countries with gross national income (GNI) per capita greater than 8000 international dollars(Int$), a second group of six countries with GNI between 2000 Int$ and 7999 Int$, and finally a third group of 33 countries with GNI less than 2000 Int$. GNI for Zimbabwe was missing.
Following Barcelo et al.(2), the authors used standard cost-of-illness methods to evaluate:
(1) The direct cost borne by the health systems and the families
(2) The indirect costs through losses of productivity due to premature mortality, permanent disability and temporary disability caused by diabetes.
The economic cost of diabetes was estimated on the basis of the average prevalence of diabetes in each group with the followings assumptions:
(a) The number of people with Type 2 diabetes represents 90% of the total number of diabetes patients and the remaining 10% were supposed to have Type 1 diabetes (page 1 of appendix, (A) Population )
(b) The total number of people in need of insulin (NI) is equal to all the Type 1 diabetes patients ( 97400, 53600 and 551000 in group 1, 2 and 3 respectively) plus 5% of the Type 2 patients (48700, 26800 and 275500 in group 1, 2 and 3 respectively) ( page 3 of appendix, (F) Insulin )
(c) The total number using syringes is equal to NI as defined in (b)
( page 4 of appendix, (G) Syringes )
(d) The number of people using reagent strips is equal to NI (defined in (b))
( page 4 of appendix, (H) Reagent strips )
(e) The number of people using glucose meters is equal to NI (defined in (b)) ( page 4 of appendix, (I) Glucose meters )
(f) The number of patients hospitalized is equal to NI as defined in (b) (page 4 of appendix, (L) Cost of Hospitalizations)
The efforts devoted by the authors to carry out this interesting study are praiseworthy. However, I would like to address the following comments:
C1) For people needing insulin, the numbers computed for the 5% of people with Type 2 diabetes are overestimated. In fact the numbers used by the authors represent (wrongly) 5% of the total numbers of diabetes patients:
(48700 = 5%*974000; 26800 = 5%*536000 and 275500 = 5%*5510000).
Consequently, the total number in need of insulin in group 1, 2 and 3 should be respectively 141200, 77700 and 798950 instead of NI1=146100, NI2=80400 and NI3=826500 used by the authors.
C2) The same ¿wrong¿ numbers NI1 , NI2 and NI3 are used to estimate:
(G) The cost of Syringes, (H) the cost of reagent strips, (I) the cost of glucose meters, and (L) the cost of Hospitalizations.
C3) In page 3, the authors explain how the Mauritanian Lipid test cost of Int$28.9 was obtained but in page 6 of appendix, the value of Int$29 for lipid profile is used in group1 while Mauritania belongs to Group3.
C4) More importantly, the authors assumed that only people using insulin (Type 1 + 5% of Type 2) were using reagent strips and glucose meters. This assumption is controversial because the vast majority of the literature on diabetes (3-6) recommends that people with Type 2 diabetes on insulin and/or tablets should regularly control their blood glucose, while the authors have considered only one HBA test per year.
C5) Similarly, the authors assumed that only people using insulin (Type 1 + 5% of Type 2) were facing hospitalization. This may be true in the case of hypoglycemic coma but in general, diabetes patients not using insulin are also susceptible to need hospitalizations especially with age and bad control.
REFRERENCES:
1. Kirigia JM, SamboHB, Sambo LG and Barry SP. Economic burden of diabetes mellitus in the WHO African region. BMC International Health and Human Rights 2009, 9:6
2. Barcelo A, Aedo C, Rajpathak S, Robles S: The cost of diabetes in Latin America and the Caribbean. Bulletin of the World Health Organization 2003, 81:19-27.
3. IFD. IFD Diabetes Atlas. 15th edition, International Diabetes Federation, Brussels, 2011
4. UKPDS (U.K. Prospective Diabetes Study) Group. 1998. ¿Intensive Blood-Glucose Control with Sulphonylureas or Insulin Compared with Conventional Treatment and Risk of Complications in Patients with Type 2 Diabetes (UKPDS 33).¿ Lancet 1998, 352 (9131): 837¿53
5. Venkat KM, Zhang NP, Kanaya AM, Williams DE, Engelgau MM, Imperatore G ,and Ramachandran A. Diabetes: The Pandemic and Potential Solutions. In Disease Control Priorities in Developing Countries, chapter 30. Jamison DT et al editors. Washington (DC): World Bank 2006
6. Bjo¨rk S. The cost of diabetes and diabetes care. Diabetes Research and Clinical Practice. 2001, 54 , suppl 1: S13-S18
7. Boutayeb A, Boutayeb S. The burden on Non Communicable Diseases in developing countries. Int J Equity Health; 2005:4(1):2
Competing interests
The author declares that He has no competing interests