Memorandum

Diabetes Care article projects global economic burden of diabetes in 2030 at $2.1-$2.5 trillion, even if SGD and WHO targets are met - March 9, 2018

Executive Highlights

  • A study published recently in Diabetes Care reported that the global economic burden of diabetes could climb to $2.5 trillion in 2030 if prevalence/mortality trends continue. This reflects 88% growth in direct + indirect costs of the disease from a base of $1.3 trillion in 2015. Even if countries meet the Sustainable Development Goals (SDG) to reduce premature mortality from NCDs and the WHO target to halt the increase in diabetes prevalence, the economic burden of diabetes will reach $2.1 trillion in 2030, rising 62% from 2015. This is a sobering result, but it means that achieving SDG and WHO goals will keep diabetes-related costs at 1.8% of average GDP (otherwise, this could climb to 2.2% of GDP). Moreover, meeting these public health targets could reduce diabetes-related mortality 11%, from >3 million annually in 2015 to ~2.8 million annually in 2030. Ultimately, we hope this analysis serves as a stark evidence for a necessary series of changes.
  • The investigators took a rigorous approach, evaluating three possible scenarios to account for changes in diabetes prevalence/mortality. The paper presents cost calculations for a (i) baseline situation, in which changes only occur due to urbanization and population aging, for a (ii) past trends situation, in which prevalence/mortality continue on a trajectory in line with previous epidemiological statistics, and for a (iii) target situation, in which countries meet the SDG and WHO benchmarks.
  • This paper presents a very important analysis, in our view, as it is the only report to comprehensively evaluate the global impact of direct and indirect costs of diabetes and its complications. ADA previously estimated the economic burden of diabetes in the US alone (in 2012), but this only considered diagnosed diabetes (while a significant percentage of cases still go undiagnosed) and direct costs. Until now, no study has investigated how achieving diabetes-related targets will affect the future global economic climate. There’s no doubt in our minds that the diabetes epidemic is growing at an unsustainable rate – the 2017 IDF Atlas listed worldwide prevalence at 425 million adults and direct costs at $727 billion – but accurate statistics on direct + indirect cost are a vital piece of persuading all healthcare stakeholders to make diabetes prevention a priority.

An article published in the February edition of Diabetes Care reported new projections for the global economic burden of diabetes by 2030. According to this analysis, even if countries meet the Sustainable Development Goals (SDG) to reduce premature mortality from NCDs and the WHO target to halt the increase in diabetes prevalence, direct and indirect costs of diabetes will hit $2.1 trillion in 2030, rising 62% from $1.3 trillion in 2015.

If current trends continue in diabetes prevalence and mortality, the global economic burden will exceed 2015 levels by 88%, totaling $2.5 trillion in 2030.

Looking at the data another way, diabetes-related spending will account for 2.2% of the global GDP in 2030 vs. 1.8% in 2015, assuming current trends persist. In the “target scenario” of SDG and WHO goals achieved, diabetes expenditures will hold at 1.8% of the global GDP.

This paper presents a very important analysis, in our view, as it is the only report to comprehensively evaluate the global impact of direct and indirect costs of diabetes and its complications. ADA previously estimated the economic burden of diabetes in the US alone (in 2012), but this only considered diagnosed diabetes (while a significant percentage of cases still go undiagnosed) and direct costs. Until now, no study has investigated how achieving diabetes-related targets will affect the future global economic climate. There’s no doubt in our minds that the diabetes epidemic is growing at an unsustainable rate – the 2017 IDF Atlas listed worldwide prevalence at 425 million adults and direct costs at $727 billion – but accurate statistics on direct + indirect cost are a vital piece of persuading all healthcare stakeholders to make diabetes prevention a priority.

We find the projections in Diabetes Care incredibly sobering. That said, while it’s tempting to adopt a fatalistic attitude here, we urge our readers to instead see the results as further evidence for a necessary change. As the article notes, it is crucial that modifiable risk factors are reduced with coordinated action from governments, international and local health agencies, and industry members. As we address these risk factors, especially the social/environmental ones, we can begin “bending the curve” so to speak, a phrase borrowed from the Cities Changing Diabetes (CCD) program. CCD acknowledges that even if cities reduce obesity rate 25% by 2045, diabetes prevalence will rise from ~9% now to ~10% then – but that’s better than a diabetes rate of ~11% in 2045, and implementing cost-effective solutions will allow cities to shift the trajectory of the epidemic, over time, from pointing up, to flat, to down.

Read on for more details on this analysis.

Background and Methods

  • The investigators explored three scenarios across 180 countries: (i) baseline, which assumes that diabetes prevalence and mortality increase only with urbanization and population aging; (ii) past trends, which assumes that prevalence and mortality increase in line with previous age- and sex-specific changes using data from the 2015 Global Burden of Disease (GBD) study; and (iii) target, which calls for one-third reduction in premature mortality due to NCDs (SDG) and reversion of age-standardized diabetes prevalence to 2010 levels (WHO). Total economic burden of diabetes was defined as the sum of excess health expenditure (direct costs) + the value of forgone production (indirect costs) due to diabetes and its complications. In all three scenarios, global economic burden is forecasted to increase by at least 62% from the 2015 total expenditure of $1.3 trillion.

Diabetes Prevalence and Mortality

  • By 2030, the global prevalence of diabetes is expected to grow from 8.8% in 2015 to 10% in the baseline scenario, 11.8% in the past trends scenario, and 9.8% in the target scenario. For context, Cities Changing Diabetes has projected ~10% worldwide diabetes prevalence in 2045 if cities successfully cut obesity rate by one-quarter (25%) in that time frame. The number of diabetes-related deaths annually is expected to rise by 33% from >3 million in 2015 to >4 million in 2030 in the baseline scenario. This value is expected to climb 45% to nearly 4.6 million in the past trends scenario, and it could actually fall 11% to 2.8 million in the target scenario, which is exciting; this is a sign that attaining SDG and WHO targets will indeed make an appreciable difference, first on diabetes-related mortality and later on prevalence and cost, as is to be expected.

Economic Burden by Region

  • North America had the highest absolute cost of diabetes in 2015 ($500 billion) and will maintain its position in 2030 per both the baseline ($702 billion) and target scenarios ($686 billion). The region will account for 32% of direct + indirect costs around the globe in the target scenario, compared to 38% in 2015. If past trends continue, then East Asia and Pacific will contribute the most (32%) to global economic burden of diabetes in 2030 ($796 billion, more than doubling from $321 billion in 2015). This is valuable insight as we think about allocating resources to vulnerable populations/regions. Since cost-effectiveness will be absolutely key in implementing successful public health initiatives (and in generating sufficient support for these initiatives), it’s helpful to have these rigorous estimates on the greatest cost drivers.
  • When this analysis looked at diabetes cost as a function of country-specific GDP, the largest rises between 2015-2030 were seen in middle-income countries. Interestingly, the high-cost countries were not sequestered in a single world region, but were dispersed globally (see image below). In all three scenarios, Latin America and the Caribbean will have the highest economic burden of diabetes relative to regional GDP by 2030. If past trends continue without intervention, the absolute cost of diabetes in Latin America and the Caribbean is projected to rise from 2.4% of GDP in 2015 to 3.4% of GDP in 2030, due to substantial predicted increases in age-specific prevalence. Again, we think this should be a signal to public health organizations, policymakers, and industry stakeholders – what cost-effective measures might be implemented in Latin America and the Caribbean to reduce the health and health economic burden of diabetes?
  • Although Sub-Saharan Africa is likely to experience considerable increases in the economic burden of diabetes by 2030, it will remain the smallest contributor to global absolute cost in all scenarios. Direct + indirect costs are expected to rise from $20 billion in 2015 to $43 billion (baseline), $52 billion (past trends), and $36 billion (target). Thus, in each scenario, Sub-Saharan Africa will reflect 2% of total worldwide diabetes spending. Looking at cost/GDP, diabetes expenditures and productivity loss in Sub-Saharan Africa look more comparable to South Asia, MENA, and East Asia/Pacific.
  • The article suggests that North America will be the only region to experience a decline in costs relative to GDP in all three scenarios. In 2015, North America accrued diabetes-related costs equivalent to 2.6% of its GDP; this declines to 2.4% in the target scenario and to 2.5% in the baseline and past trends scenarios. However, there are no projected decreases in direct costs, implying that the favorable changes in North America are entirely due to decreases in indirect costs relative to GDP. Notably, indirect costs only arise from productivity loss in working-age individuals, and therefore, they do not include people over age 65 (certainly, we see diabetes in older populations as an ever-pressing problem in the US and other North American countries). The paper proposes two factors contributing to this downward trend in cost as a fraction of GDP: (i) Demographic developments in North America suggest a decrease in the population <65 years-old, and (ii) recent growth in age- and sex-specific prevalence has been modest, thereby tempering the cost increases even in the past trends scenario. Still, we want to emphasize that this is nothing to celebrate, given the continued climb in direct diabetes-related costs. To be sure, there’s more work to be done on the diabetes epidemic in North America; the CDC just came out with its latest Diabetes Report Card, showing 1.4 million new cases in 2015 which put prevalence at 30.3 million people in the US (i.e. 12% of all adults have diabetes).

*Note that A represents baseline scenario, B represents past trends scenario, and C represents target scenario.

 

-- by Maeve Serino, Payal Marathe, and Kelly Close