Sunday, February 19, 2006

Economics of diabetes screening

A couple of years ago, after a general medical checkup, I got the standard: ‘Good or bad news first’ line from my amiable GP. The bad news was that, along with a million other Australians, I had diabetes 2 (or DM = diabetes mellitus). This is one of the commonest, non-communicable diseases in the world. Its causes include excess carbohydrate intake, aging and ethnic predispositions (see here). Often the disease is associated with higher than average bodyweight

Of the 14% of Australians who self-report their health status as ‘fair’ or ‘poor’ about 50% have a form of diabetes. The DM variant of diabetes accounts for 87% of Australian diabetics

DM develops gradually but its development can be forestalled (or avoided) by losing weight, controlling carb intake and by exercising. Moreover, if it simple to identify someone close to acquiring DM or with DM using inexpensive medical procedures such as glucose tolerance tests. And, if DM is identified early enough, as it was in my case, it is often easy (given enough self-control on the part of the patient) to self-manage DM with drug therapies, weight loss, exercise and dietary control. I don't take drugs myself but do exercise and do watch my carb intake.

There is a strong argument for all people to be tested for diabetes on a regular basis if they are overweight and particularly if they are getting past age 40. Such tests are inexpensive and, if left unidentified, DM can produce catastrophic outcomes including damage to various parts of the body with microvascular and macrovascular disease including heart disease, stroke, blindness and even amputation of limbs. There may be an argument for subsidizing DM testing, for encouraging employers to have their employees tested and/or perhaps for publicly-funded information campaigns concerning the desirability of screening for the disease.

Consider the DiabCo$t study of 10,500+ adults with DM. Of these:

  • 22% had only microvascular complications (eye problems, kidney damage, foot or leg ulcers).
  • 2% had only macrovascular complications (heart attack, stroke or amputations).
  • 9% had both microvascular and macrovascular complications.

Average annual health costs/per person of the disease were $5360 in direct costs. Health care costs contributed 79% of costs with medications accounting for only 30%. The complications mentioned, which occur only in a relatively small number of DM sufferers, were the main driver of diabetes costs. Annual costs without complications were $4025, $7025 for those with only microvascular complications, $9055 with macrovascular complications and $9645 for those with both.

The total annual treatment costs to Australia of DM are around $6 billion. An early detection program, would cost a fraction of this, avoid substantial treatment costs and reduce or delay the human misery associated with the onset of diabetic complications.

I am interested in further studying the economics of DM and its screening and looking for a PhD student to work in this area.

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