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The Socio-economic Burden of Diabetes in Developing Countries Lessons from studies in Egypt

The Socio-economic Burden of Diabetes in Developing Countries Lessons from studies in Egypt. Professor Morsi Arab Egypt.

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The Socio-economic Burden of Diabetes in Developing Countries Lessons from studies in Egypt

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  1. The Socio-economic Burden of Diabetes in Developing CountriesLessons from studies in Egypt Professor Morsi Arab Egypt

  2. Socioeconomics of Diabetes1- The patient and human environment.2- Patient’s Right and Obligations.3- Factors deciding the burden of diabetes.4- Size of the problem : Prevalence 5- Life Style 6- The national cost7- Government and Household expenditure.8- Cost of O.P. care9-The hospital burden 10- Costs comparative to other countries .

  3. The people with Diabetes and their Environment IDF Media Public . Com. Diab. Associations Patient Friends Family Health Care Team Syndicates Pharm. Ind. Health Autho. WHO

  4. Determinants of impact • 1. High prevalence • 2. High cost of disease • 3. Low economics • 4. Adverse social conditions

  5. CAIRO

  6. Geographical distribution of the Egyptian population 43% 1% 56%

  7. 60 -60 -50 -40 -30 -20 -10 40 30 20 10 0 10 20 30 40 Age structure of the Egyptian population

  8. The estimated prevalence with DM by IDF region, 2000 Prevalence (%) Region

  9. Prevalence of DM in the whole of Egypt in different age groups Prevalence (%) ?

  10. Prevalence of DM Prevalence (%) Age range

  11. Effect of change of the life style in migrating ethnic groups on metabolic parameters related to diabetesA lesson from the Nubians of Egypt Professor Morsi Arab University of Alexandria - Egypt

  12. Prevalence of DM in patients over 40 yrs % Prevalence (>40yrs)

  13. Conclusions 1. Changes in life style (diet & exercise( of susceptible individuals or groups is liable to increase their predisposition to DM (incidence of transformation of IGT to DM and consequently increased DM prevalence). 2. The change is more profoundly demonstrated among groups that might be originally protected by some genetically inherited characteristics. 3. Most of the parameters of the metabolic syndrome seem to be closely bound together and are prone to change under the influence of the adverse changes of life style.

  14. Controlled metabolic parameters (% in diab. population Egypt 2003 ) - Fasting Bl. Glucose : 19.8% - P.P Bl. Glucose : 21.4% - S. Cholesterol : 56.4 % - S. Triglycerides : 50.4% - Syst. B.P. : 53.7% - Diastolic B.P. : 64.6%

  15. Diabetes Complications (Egypt2003) % in Diabetic population Retinopathy : 32.3% Neuropathy : 55.5% Nephropathy : 5.0% Cardiac Dis. : 21.3% Foot ulcers : 6.8% Foot amputations : 3.0% Foot deformities : 1.0%

  16. The cost of Diabetes Data from Alexandria hospitals

  17. Medical supplies: insulin etc.… Doctors Lab charges Basal cost: Salaries, equipment, food, water, electricity’ laundry etc. Control of diabetes: Insulin, OHA, medical supplies Rx complications: Antibiotics, laser, haemo- dialysis , surgery etc. Allocation of Direct Costs in hospital DIRECT COST Hospital care Out-patient

  18. Loss of working hours Diabetes mortality Premature death Indirect Costs PRODUCTION

  19. The cost of diabetes in Egypt Alexandria Hospitals (86/88) • O.P. care (per person per year) • Doctors’ charges: 35.84 L.E. • Medical supplies 30.36 L.E. • Laboratory charges 19.68 L.E. 85.88 L.E. per year • In-patient hospital care • Average total cost for one single admission/year, at average stay: 148.31 L.E. per year

  20. The economic burden of direct cost of DM • Total direct cost of diabetes in 1986: 160m • Average inflation rate (1986-90) 11.85% • Estimated total direct cost in 1990 235.2m • Total Government expenditure on health, 1990: • National production 31.3bn • Government expenditure at 40% 12.6bn • 2.8% Gov. expenditure on health 351.8m

  21. DIRECT COST OF TREATMENT OF DM L.E.235.2m AVAILABLE GOVERNMENT EXPENDITURE ON HEALTH L.E. 351.8m Cost of DM in relation to funds available 2/3!!

  22. National economics and Reflections on health • Per capita income • %Government expenditure on health • % Household consumption PARAMETERS

  23. Gross National Product/Capita $000s N I E S EE

  24. Percentage share of government expenditure % N I E S EE Health Education Defence

  25. Percentage share of total household consumption % N I E S EE Medical care Total food Education

  26. Kuwait Emerates Qatar Bahrain Oman Saudi Arabia Libya Israel Syria Jordan Tunisia Egypt Turkey Yemen Middle East Countries - economic status HIGH ECONOMY MIDDLE ECONOMY LOW ECONOMY • Iraq • Cyprus • Iran >5,000US$ <2,000US$

  27. Cost of out-patient ambulatory care of DM in Egypt compared with other Mediterranean countries (US$/month) *including treatment by dialysis

  28. Socio-economics - Some health and education parameters in 20 African countries

  29. Socio-economics - Increasing total calorific intake

  30. Distribution of costs of Hospital Treatment of Diabetic Patients ( L.E. per day ) at a Private Hospital for Middle Class Egyptian Population at the City of Alexandria , Egypt 2001

  31. Distribution of Hospital Cost 45% Basic ( Food : 5% H.C.Team 11% Others: 29%) 55% Medicine & Supp.

  32. Hospital Treatment 2001 Cost /Day

  33. Estimated Costs of Ambulatory (out patient) Treatment of Diabetes in Egypt at 2001 Cost Prices in USD/ year (A) Insulin ( Dose 10-80 units /d ) (B) Oral Antidiabetic Agents * Heavily subsidized ** moderately subsidized

  34. Cost of O.P. Treatment (Egypt 2001) $/ y Animal u/40 Human u/40 Human u/100 Human/pen Metformin Glibenclam Gliclazide Glimeperide Rapiglinide Nateglinide Rosiglitazone

  35. Estimated Costs of Ambulatory (out patient) Treatment of Diabetes in Egypt at 2001 Cost Prices in USD/ year ( Cont.) • ( C ) Other costs at average frequencies per year • Laboratory , and other follow – up investigations (E.C.G radiol., etc. ) • Physician fees and other specialist consultations • Total 143 USD/Year • 76.4 • 66.6

  36. The Burden of the Cost of Ambulatory Treatment of Diabetes on Individuals at Low-Income and High-Income Middle East Countries, based on the Cost Prices of Insulins and Oral Antidiabetic Agents (in USD per year) * Heavily subsidized ** moderately subsidized

  37. Year Cost / percapit. Burden for Human Insulin (40 u /d) 8.85% EGYPT 1.9% 3.1% SAUDI ARABIA QATAR

  38. The Burden of the Cost of Ambulatory Treatment of Diabetes on Individuals at Low-Income and High-Income Middle East Countries , based on the Cost Prices of Insulins and Oral Antidiabetic Agents ( in USD per year) (Cont.)

  39. The Burden of the Cost of Ambulatory Treatment of Diabetes on Individuals at Low-Income and High-Income Middle East Countries , based on the Cost Prices of Insulins and Oral Antidiabetic Agents (in USD per year) (Cont.)

  40. Cost Burden of Oral Treatment related to Percapitum 4.2% 29.9% EGYPT QATAR 8.4% SAUDI ARABIA

  41. Socio-economic impact on diabetes education -1 1.Lower economy; • less available resources for education 2. Lack of rational plan for: • patient education • physician education • other health personnel (nurses,dieticians,foot care etc…) • general public (awareness: food intake, obesity, exercise, early detection etc…)

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