The economic burden of diabetes in Ireland

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O'Neill, Kate N.
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University College Cork
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Background and Aims: As a leading cause of morbidity and mortality, diabetes places a significant burden on society and presents a growing challenge for national economies. The economic burden of diabetes is forecast to grow in coming years, driven by increasing diabetes prevalence and rising medical expenditure. Worldwide, there is a lack of robust, comprehensive and comparable estimates of costs attributable to diabetes. Cost-effective interventions are required to efficiently manage and treat diabetes and curb increasing trends in incidence. Three effective interventions spanning the prevention continuum have recently been recommended in Irish health policy and can potentially influence the burden of diabetes; a sugar-sweetened beverage (SSB) levy, financial remuneration for the provision of structured diabetes care in primary care through the ‘cycle of care’ initiative and bariatric surgery. The overarching aims of this thesis were to estimate the economic burden of diabetes in Ireland and to explore the potential for current policy approaches to impact on the burden of diabetes. Methods: The economic burden of diabetes was estimated from a societal perspective employing an incremental costing approach where possible. Nationally representative data from The Irish LongituDinal study of Ageing (TILDA) and the national pharmacy claims database, Health Service Executive – Primary Care Reimbursement Service (PCRS), were utilised. Direct costs included health service utilisation costs and medication costs while indirect costs included productivity losses from reduced labour force participation and premature mortality. The impact of diabetes on health service utilisation and productivity were explored using multivariable regression models. Trends in pharmaceutical expenditure on diabetes between 2011 and 2015 were explored. Total expenditure associated with diabetes was calculated by extracting data on all diabetes-related items dispensed. A comparative risk assessment was conducted to robustly estimate the potential impact of a reduction in population-level SSB consumption on type 2 diabetes incidence. Using data from the Survey of Lifestyle, Attitudes and Nutrition (SLAN), the potential impact of a 10% levy on SSBs was explored. An assessment of the potential impact of the ‘cycle of care’ and bariatric surgery provision on the burden of diabetes was conducted using a cross-sectional analysis of TILDA. Results: Diabetes was associated with excess health service use across the entire health system and was also adversely associated with productivity. Compared to those without diabetes, people with diabetes have on average 1.49 (95% CI: 1.10, 1.88) additional GP visits annually. Diabetes was associated with an 87% increase in out-patient visits, 52% increase in hospital admissions and 33% increase in A&E attendances (p<0.001). People with diabetes were 41% less likely to be employed than those without diabetes (p<0.001). The total costs of diabetes in those aged over 50 years in Ireland was estimated at €545,787,911 (95% CI: 365,597,451 – 766,782,103) in 2013; €238,155,072 (95% CI: 192,023,954 – 278,959,992) in direct costs and €307,632,839 (95% CI: 173,573,497 – 487,822,111) in indirect costs. Over the five-year period from 2011 to 2015, the cost of prescription items used specifically in the treatment and management of diabetes increased by 18%, reaching €153,621,477 in 2015, with blood glucose-lowering medications accounting for 73% of this increase. The introduction of a 10% SSB levy is estimated to prevent 0.25% (95% UI: 0.01%,0.5%) of incident type 2 diabetes cases in a ten-year period. While the majority of people with type 2 diabetes are covered by the ‘cycle of care’ initiative, 31.6% (95% CI: 27.8, 35.6) are not eligible. Current eligibility criteria do not identity people on the basis of clinical need but rather on income. With fewer than 50 publicly funded bariatric surgeries taking place annually, current service provision meets less than 0.1% of the need. Conclusion: Diabetes places a substantial burden on the Irish health system as well as the national economy. The estimates provide useful information to inform policy-level responses to tackle the burden of diabetes. With findings demonstrating increasing pharmaceutical expenditure on diabetes in recent years, combined with the increasing prevalence of diabetes in Ireland, the economic burden of diabetes is likely to increase. Population-level interventions targeting SSB consumption can play a role in the primary prevention of type 2 diabetes. The potential impact of effective tertiary prevention interventions, as recommended and supported by Irish health policy, are limited by inequitable and inadequate investment.
Diabetes , Cost of illness
O'Neill, K. N. 2018. The economic burden of diabetes in Ireland. PhD Thesis, University College Cork.
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