Cost-of-illness and associated factors among persons with type 2 diabetes: Findings from a tertiary care center in South India

Objective

Our aim was to estimate the cost of illness (COI) from the patient's perspective among individuals with type 2 diabetes (PWDs) attending a public tertiary care center in southern India.

Methods

This cross-sectional analytical study included PWDs on treatment for at least one year. Interviews captured direct medical costs (hospitalization, tests, medications), direct non-medical costs (meals, travel), and indirect costs (wage loss). Median regression analyses examined factors associated with total COI.

Results

Of total 1002 PWDs included, the mean (SD) age was 56 (12) years. Majority were males and from rural areas. One-third had diabetes for more than ten years, half were on insulin therapy, and more than half had comorbidities. Median (IQR) reported household income was US$637 (US$318–US$1115)/year. The Median (IQR) annual COI was US$39 (US$20-US$67), of which 73% was direct costs with a median of US$28. Majority of the participants (n=818, 81.6%) spent on laboratory investigations as direct medical costs and travel (n=1000, 99.8%) as direct non-medical costs. Travel costs represented the largest share of total COI (41%), followed by wage loss. Median annual COI was higher for males, salaried PWDs, and PWDs on insulin.

Conclusions

Our findings highlight that PWDs attending a public tertiary care center bear significant out-of-pocket expenses for diabetes care, primarily due to direct costs. Particularly, travel costs were identified as the most substantial component of the total COI.