Diabetes mellitus as an economic problem in Russian Federation

Objective. To estimate annual expenditures attributed to diabetes mellitus (DM) per patient in Russia based on data from epidemiologic studies and to analyse DM cost drivers. Methods. The expenditures per diabetic patient were calculated as the sum of medical costs (outpatient and emergency room visits, inpatient care and medications provided during outpatient care), payments for sick leaves, disability pensions and gross domestic production (GDP) losses due to temporary disability (indirect costs). All data on resource consumption and productivity losses were derived from the dataset for Russia, collected from the point of view of a multicentre international study on the practice of DM treatment. Medication costs were based on registered governmental price lists (list of vital and essential drugs). Medical care costs were estimated using the approved public health care reimbursement rates. Disability payments were calculated on the basis of data published by the Russian Pension Fund and Social Security Fund. GDP losses were assessed using federal statistics. Results. The mean total annual costs per patient with DM type 1 (T1) were 81.1 thousand Russian rubles (RUR) and those per patient with DM type 2 (T2) were 70.8 thousand RUR. Although most patients with DMT2 were >60 years, approximately 25% of costs were nonmedical and caused by productivity losses; for patients with DM type 1(T1), this proportion was 35%. The medical cost structure differed depending on the type of diabetes. In T1, the main component was attributed to DM treatment; in DMT2, almost half of medical costs were due to DM complications. Medication costs accounted for 69% and inpatient care accounted for only 22% of medical costs in DMT1. For DMT2, the proportion spent on inpatient care (43%) was almost equal to medication costs (46%). Mean expenditures per patient with DM complications were higher; in the case of DMT2, the presence of complications increased the costs by 3 times. Mean medical costs were higher for patients not reaching the target level of Hb1Ac than those reaching it, despite age or the presence of complications. The results of regression analysis showed that the strongest predictors of costs growth were the number of admissions, presence of complications and insulin treatment. It was also demonstrated that the mean medical cost per patient with uncomplicated DM T2 on insulin therapy was 38.5 thousand RUR, which was comparable to the cost per patient with complications, receiving other glucose-lowering treatment (37.0 thousand RUR). Conclusion. Costs for patients with DM complications are considerably higher than those for patients without complications. Therefore, the key point in controlling the growth of the DM economic burden is to minimise and/or prevent the development of DM complications, which could be achieved by timely DM diagnosis and appropriate glucose-lowering therapy.