The Costs of Chronic Diseases in Latin America and the Caribbean: the Case of Diabetes

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Regional Workshop The Economic, Fiscal and Welfare Implications of Chronic Diseases in the Americas The Costs of Chronic Diseases in Latin America and the Caribbean: The Case of Diabetes

Alberto Barceló, MD, MSc PAHO, Washington DC, USA Outline

• The burden of diabetes in Latin America & the Caribbean • The Burden of Diabetes Mortality in the Caribbean • The Cost of Diabetes Screening: An Example from Brazil • Cost evaluation with IDF • Conclusions ChronicChronic CareCare ModelModel

HEALTH SYSTEM

COMMUNITY Health Care Organizations Self- Clinical Resources & Management Information Policies Support Delivery Decision System System Design Support

Informed, ProductiveProductive Prepared, Empowered InteractionsInteractions Proactive Patient Practice Team

Improved Outcomes

PREVALENCE Prevalence estimates of diabetes in the Americas, 2000-2025*

Prevalence (%)

3.1– 4.0 4.1- 5.0 5.1- 6.0 6.1- 8.2 8.3-12.2

2000: 35 Million 2025: 64 Million

* Source: King H, Aubert RE, Herman WH. Global Burden of Diabetes, 1995- 2025. Diabetes Care 1998;21:1414-1431 GLOBAL PROJECTIONS FOR THE NUMBER OF PEOPLE WITH DIABETES (20-79 AGE GROUP), 2007 and 2025 (MILLIONS) Prevalence (%) of diabetes among adults in the

Barbados 16.4 Americas Trinidad/Tobago 12.7 Jamaica 12.6 Belize 12.4 Cuba 11.8 Mexico 10.7 US Blacks 10.4 Nicaragua 9 Mexican Americans 9 Suriname 8.7 Bolivia 8.6 Guatemala 8.4 Colombia 8.2 Costa Rica 7.9 USA total 7.8 Argentina 7.6 Brazil 7.6 US Whites 7.5 Haiti 7.3 Paraguay 7.2 Urban Peru 7.2 Chile 6.3 Honduras 6.1 Source: Pan Am J Public Health 10(5), 2001; unpublished (CAMDI), Haiti (Diabetic Medicine); USA (Cowie, Diabetes Care) Prevalence of DM (%) and 95%-CI among adults by country, the CAMDI Study.

12.90

9.80 10 8.80 8.50 Percent 7.60 7.30 5.40

0 Belize San Jose San Salvador Guatemala City Tegucigalpa Managua TOTAL

Barceló A, et al. The Growing Threat of Diabetes in the Developing Americas: The Central America Diabetes Initiative. In preparation, 2008. Crude and Standardized Prevalence (%, 95%-CI) of Diabetes by site. The CAMDI Survey, 2002-2005

20.0 17.4 15.0 14.7 12.9 11.0 11.5 10.0 10.4 10.3 9.8

PERCENT 8.8 8.5 7.6 7.3 7.6 5.0 5.4

0.0 CRUDESTANDCRUDESTANDCRUDESTANDCRUDESTANDCRUDESTANDCRUDE STAND CRUDE STAND Belize S Jose S Salvador Guatemala C Tegucigalpa Managua TOTAL

Standardized by the direct method using the US 60 57 2000 Census population as standard 50 41 42 40 34 30 17 20 9 10 0 20-39 40-64 65+ 20-39 40-64 65+ Central America US 2000 Census In Latin American and the Caribbean, it has been demonstrated that people with diabetes are 1.5 times less frequently employed (36% vs. 56%), 1.8 times less likely to achieve a technical or university degree (7.8% vs. 13.8%), and 2.6 times more frequently permanently disabled (8% vs. 3%).

Source: Morice et al, Costa Rica, 1999 The Cost of Diabetes in Latin America and the Caribbean 2000

Direct 16%

Indirect 84% Latin America and the Caribbean Population = 500 million People with diabetes = 15.2 million

Indirect Cost

Deaths Temporarily Permanently = 339,035 disabled disabled = 726,575 = 2.4 million Cost of diabetes Indirect Direct

Disability

Mortality Temporary Permanent Number 339,035 6,096,500 726,57 5 YPLL 757,096 136,701 12,699,087 Cost(US$) $ 3,099 M $ 763 M $ 50,633 M Direct Costs

Hospitalizations Consultations Complications

1,012.0 M US$ 2,508.4M US$ 2,480.4 M US$

Drugs/ Lab

Insulin Total= US $ Oral drugs 10,721 billion 1,940 M US$ 2,780 M US$ Direct Cost of Diabetes in Latin America and the Caribbean

Complications Insulin 23% 18%

Hospitalizations 9% Oral Medication 27% Consultation 23% The Cost of Diabetes Complications in Latin America and the Caribbean

Neuropathy PVD Retinopathy 3% 3% 11% CVD 10%

Nephropathy 73% The Burden of Diabetes Mortality in the Caribbean Aim

• to estimate the economic cost attributed to diabetes mortality in 10 English speaking Caribbean countries (Antigua & Barbuda, the Bahamas, Barbados, Belize, Dominica, Jamaica, St. Vincent & the Grenadines, St. Kitts and Nevis, St. Lucia and Trinidad & Tobago). Methods

A prevalence-based approach using the Population Attributable Fraction (PAF) was combined with the human capital approach to estimate Years of Potential Life Lost (YPLL), and Years of Productive Life Lost (YPLL) due to diabetes mortality among people aged 40 years and older PAF = Pe (RR-1)/(1+(P e(RR-1))) [1]

Pe – proportion of the population exposed to the factor RR – unadjusted relative risk of mortality associated with diabetes