Indian Journal of Endocrinology and Metabolism

LETTER TO THE EDITOR
Year
: 2014  |  Volume : 18  |  Issue : 4  |  Page : 587-

Comment on the editorial "Health Economics in India: The case of diabetes mellitus"


Koteshwara Muralidhara 
 Consultant Diabetologist, Birmingham Community Healthcare NHS Trust, Birmingham, United Kingdom

Correspondence Address:
Koteshwara Muralidhara
Birmingham Community Healthcare NHS Trust, Lansdowne Road, Birmingham B18 7AA
United Kingdom




How to cite this article:
Muralidhara K. Comment on the editorial "Health Economics in India: The case of diabetes mellitus".Indian J Endocr Metab 2014;18:587-587


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Muralidhara K. Comment on the editorial "Health Economics in India: The case of diabetes mellitus". Indian J Endocr Metab [serial online] 2014 [cited 2021 Mar 4 ];18:587-587
Available from: https://www.ijem.in/text.asp?2014/18/4/587/137502


Full Text

Sir,

I read with interest the editorial on Diabeto-economics by Sahay, Barua and Kalra. [1] I could not agree more with the authors on the urgent need for a multidisciplinary clinical-economic analysis of diabetes care in India at macroeconomic and microeconomic levels. The comprehensive editorial discusses how cost-benefit studies have helped us to identify and improve certain aspects of diabetes care around the world, but ignores discussion on overarching economic impact of diabetes and its care to national economy at macroeconomic level. In developed countries like the UK, where health care is free at the point of delivery, there is increasing concern about unsustainability of free diabetes care as the prevalence and incidence of diabetes continues to increase. This has lead to increased focus on diabetes prevention strategies that have now drawn the attention of the national policy makers. In 2010-2011 the diabetes related direct costs in the UK was ͳ9.8 billion, whereas the indirect costs were ͳ13.9 billion. [2] The total amounted to 10% of the total health resource expenditure, which is estimated to increase to 17% by 2035 if there is no improvement on current care provision. [2] It is important to note that nearly 80% of this expenditure was on avoidable complications.

One can assume that the picture in India is no different to that of the UK going by the studies quoted by the authors and some recent publications that highlight the burden on individual patients in India. [3],[4] These studies, however, fail to address the indirect cost to the individual and the family, leave alone the cost to the nation. The data on bankruptcy is disturbing enough, but the negative impact of this on inadequate resources for proper child care and education can be telling on the economic future of the nation.

As much as I agree with the authors on the urgent need for studies to estimate the impact, I would argue that there is a more urgent need to act on the information already available from studies with in India and from those that can be extrapolated from elsewhere in the world. This action must focus on educating health care professionals on the macro and microeconomic impact of diabetes while discussing and deciding treatment options for individual patients. Also, wider implementation of nationally agreed guidelines on the cost-effective use of medications must be supported by peer bodies that must influence the policy makers. Active data collection and analysis on prescribing practice at state and national level can help in identifying variation and to implement quality and cost improvement measures. Peer-networks and national bodies must work with Government agencies and non-governmental organisations to propagate diabetes prevention education to urban and rural population through schools, religious organizations, mass media, and electronic media as a priority. The urgency for these actions cannot be stressed as I think, without these measures it may be impossible to keep the economic burden of diabetes within a manageable reach in the years to come.

References

1Sahay R, Baruah MP, Kalra S. Health economics in India: The case of diabetes mellitus. Indian J Endocr Metab 2014;18:135-7.
2Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med 2012;29:855-62.
3Akari S, Mateti UV, Kunduru BR. Health-care cost of diabetes in South India: A cost of illness study. J Res Pharm Pract 2013;2:114-7.
4Singh J. Economic Burden of Diabetes. In: Muruganathan A, Geetha T, editors. Vol. 23. Medicine Update. Association of Physicians of India, India; 2013. p. 205-8.