Economic burden of diabetes mellitus in western India: a hospital based study

Arpit Prajapati, Nitin Kothari, Barna Ganguly


Background: Descriptive cost of illness study can provide an overall picture of diabetes in monetary terms in developing country, which may serve as a vital source of information for health care organizations and planning bodies to plan and prioritize local health policies and schemes. The aim was to explore cost description of diabetes in a tertiary care hospital in Anand district of Gujarat, India.

Methods: This was an observational study with one year follow up. Ethical approval was taken from IEC. Patients were recruited and were divided into three categories according to duration of diabetes; newly diagnosed cases as category I, diabetes since last 5 year as category II and since last 10 years as category III. All these patients were followed up with 4 visits. Cost was calculated into three components; direct medical, direct non-medical and indirect cost. Descriptive and regression analysis was done using SPSS version 17.0.

Results: Total 90 patients were analyzed after 12 patients were lost to follow up, 30 in each category. Mean total cost was found to be 12391.84 INR. Contributions from direct medical cost, direct non-medical cost and indirect cost were 74%, 2% and 24% respectively. Maximum cost incurred was due to medicine cost (44.14%) followed by complication cost (43.34%).

Conclusions: Heavy economic burden highlights the urgent need for the health care organizations to plan and prioritize policies and accordingly in prevention and management of diabetes and its complications.


Cost of illness, Direct cost, Indirect cost

Full Text:



Davey PG, Malik M, Dodd T, MacDonald T. Pharmacoeconomics and Drug Prescribing. In: Speight TM, Holford NHG, editors. Avery’s drug treatment. 4th ed. Auckland: Adis International; 1997. p. 393-422.

Townsend RH. Post-marketing drug research and development. Drug Intell Clin Pharm. 1997;21:134-6.

Songer TJ, Ettaro L. Studies on the Cost of Diabetes. Prepared for Division of Diabetes Translation Centers for Disease Control and Prevention Atlanta, GA. 1998 Jun.

World Health Organization. Health Economics, drug and health sector reform. WHO task force on health economics. 1996.

Sicree BR, Shaw J, Zimmet P. The Global Burden Diabetes and Impaired Glucose Tolerance: IDF Diabetes Atlas. 4th edition [Online] 2009 [cited 2011 Nov 7]. Available from: URL:

Gor A, Kothari N, Shah P, Gaur K. Use of complementary and alternative medicine (CAM) in patients with essential hypertension and diabetes mellitus attending a tertiary care teaching hospital. Int J Med Sci Den Health. 2015;1:50-7.

Upadhyay TR, Kothari N, Shah Hitesh . Association Between Serum B12 and Serum Homocysteine Levels in Diabetic Patients on Metformin. Journal of Clinical and Diagnostic Research. 2016;10:BC01-4.

Agrawal NK, Singh R, Kothari N, Bala S, Gupta U. Evaluation of the Effect of Perindopril and its Combination with Oral Anti-Diabetic Drugs on Blood Sugar Levels in Diabetic Wistar Rats. Asian Journal of Biomedical and Pharmaceutical Sciences. 2014;4:44-9.

Agrawal NK, Sindhu S, Kothari N, Chandra S, Garima G, Gupta U. Antidyslipidemic activity of acacia tortilis seed extract in alloxan-induced diabetic rats. Int J Basic Clin Pharmacol. 2016;5:1389-96.

Zhang P, Zhang X, Brown JB, Vistisen D, Sicree RA, Shaw J, et al. Economic impact of Diabetes: IDF Diabetes Atlas. 4th edition [Online]. 2009 [cited 2011 Nov 7]. Available from: URL:

Ramachandran A, Snehlata C, Kapur A, Vijay V, Mohan V, Das AK, et al. Diabetes Epidemiology Study Group in India (DESI): High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia. 2001;44:1094-101.

World Health Organization. Demographic trends. In: Health Situation in the South East Asian Region 1998–2000. Regional Office for South East Asia, New Delhi, 2002;17-30.

Ramachandran A, Snehalatha C, Baskar ADS, Mary S, Kumar CK, Selvam S, et al. Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India. Diabetologia. 2004;47:860-5.

Peters DH, Yazbeck SA, Sharma RR, Ramana GNV, Pritchett LH, Wagstaff A. A better health systems for India’s poor: Findings analysis and options. World Bank; 2002. Available from URL:

Kapur A. Economic analysis of diabetes care. Indian J Med Res. 2007;125(3):473-82.

Barcelo A, Aedo C, Rajpathak S, Robles S. The cost of diabetes in Latin America and the Carribbean. Bull World Health Organ. 2003;81:19-28.

Shah A, Jenkins R. Mental health economic studies from developing countries reviewed in the context of those from developed countries. Acta Psychiatr Scand. 2000;101:87-103.

Rice DP, Miller LS. Health economics and cost implications of anxiety and other mental disorders in the United States. Br J Psychiatry. 1998;34:4-9.

McCrone P, Weich S. Mental health care costs: paucity of measurements. In: Thornicroft G, Tansella M, eds. Mental health outcome. London: Springer, 1996:131–42.

Songer TJ. The economics of diabetes care:USA. In: Alberti KGMM, Zimmet P, DeFronzo RA, eds. International textbook of diabetes mellitus. 2nd ed. Chichester: Wiley, 1997.

Grover S, Avasthi A, Bhansali A, Chakrabarti S, Kulhara P. Cost of ambulatory care of diabetes mellitus: a study from north India. Postgrad Med J. 2005;81:391-5.

Kapur A. Economic analysis of diabetes care. Indian J Med Res. 2007;125(3):473-82.

Bhaskaran VP, Rau NR, Satyashankar, Acharya RR, Chinnappa S, Metgud, et al. A Study of the Direct Costs Incurred by Type-2 Diabetes Mellitus Patients for their Treatment at a Large Tertiary-Care Hospital in Karnataka, India. J Acad Hosp Adm. 2003;15(2):7-12.

Esteghamati A, Khalilzadeh O, Anvari M, Meysamie A, Abbasi M, Forouzanfar M, et al. The economic costs of diabetes: a population-based study in Tehran, Iran. Diabetologia. 2009;52:1520-7.

Riewpaiboon A, Chatterjee S, Piyauthakit P. Cost analysis for efficient management: diabetes treatment at a public district hospital in Thailand. Int J Pharm Pract. 2011;19:342-9.

Khowaja LA, Khuwaja AK, Cosgrove P. Cost of diabetes care in out-patient clinics of Karachi, Pakistan. BMC Health Services Research. 2007;7(189):1-8.

Barcelo A, Aedo C, Rajpathak S, Robles S. The cost of diabetes in Latin America and the Carribbean. Bull World Health Organ. 2003;81:19-28.

Sachidananda A, Lin JTG, Usha A. Health care cost incurred by patients of diabetes mellitus in a tertiary care hospital setting in coastal karnataka district. Journal of Global Pharma Technology. 2010;2(6):8-12.

Bjork S, Kapur A, Sylvest C, Kumar D, Nair J, Kelkar S. Diabetes Care Organization and Economics - the Economic Burden of Diabetes in India: results from a National Survey. In: Forum 9; 2005 Sep 12-16; Mumbai, India.

Kumar A, Nagpal J, Bhartia A. Direct Cost of Ambulatory Care of Type 2 Diabetes in the Middle and High Income Group Populace of Delhi: The DEDICOM Survey. J Assoc Physicians India. 2008;56:667-74.

Rayappa PH, Raju KNM, Kapur A, Bjork S, Sylvest C, Kumar KMD. Economic cost of diabetes care the bangalore urban district diabetes study. Int J Diab Dev Countries. 1999;19:87-97.

Segel JE. Cost-in-Illness Studies - A Primer. RTI International RTI-UNC Center of Excellence in Health Promotion Economics. 2006.

Sanchez LA. Pharmacoeconomics: Principles, Methods, and Application. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, et al, editors. Pharmacotherapy a pathophysiologic approach. 7th ed. New York (NY): McGrawHill Medical; 2008. p. 1-14.