Health Economics & Non-Communicable Disease

Cost of Type 2 Diabetes Mellitus in Selected Developing Countries

Abstract and Background

The increasing prevalence of chronic diseases has emerged as a major contributor to the rapid rise in healthcare costs across developing countries. At the time of this review’s publication, chronic non-communicable diseases were estimated to account for approximately 54% of deaths in developing countries, a proportion predicted to rise to 65% by 2030. Among these chronic conditions, diabetes mellitus stands out as one of the most prevalent and economically burdensome, affecting more than 180 million people globally with projections suggesting the number would reach approximately 400 million by 2030.

This review article, published in the Malaysian Journal of Public Health Medicine in 2010, synthesised available evidence on the economic burden of type 2 diabetes mellitus (T2DM) in selected developing countries. The authors, drawn from leading Malaysian public health and health economics institutions, sought to provide health policymakers with a comprehensive understanding of diabetes costs to inform resource allocation and prevention strategies.

The Global Diabetes Burden

The review documented the alarming trajectory of the global diabetes epidemic, with particular attention to its disproportionate impact on developing countries. Annual deaths attributable to diabetes were estimated at approximately 3 million globally, with more than 80% occurring in developing countries. The economic impact extends far beyond direct medical costs, encompassing lost productivity, premature mortality, disability, and reduced quality of life that collectively impose a staggering economic toll on already resource-constrained health systems.

In Asia, India, China, and Indonesia were identified as the three countries with the greatest number of people living with diabetes. The total number of diabetes cases in these three countries alone was expected to more than double from 61 million in 2000 to 163 million in 2030, driven by urbanisation, dietary transitions, physical inactivity, and population ageing.

Economic Cost Assessment

The review presented evidence on both direct medical costs (medications, hospitalisation, outpatient visits, laboratory investigations, and management of complications) and indirect costs (productivity losses, disability, and premature mortality) of T2DM across several developing countries. At the global level, diabetes-related healthcare expenditure was estimated to rise from US$286 billion in 2003 to US$396 billion in 2025.

The macroeconomic impact was found to be substantial, with China and India projected to suffer cumulative GDP losses of 13.8% and 16.7% respectively over a ten-year period. These figures reflect not only the direct costs of medical care but also the broader economic consequences of a disease that affects working-age populations and reduces labour force productivity.

Cost Evidence from Malaysia

The review included evidence from several Malaysian studies on diabetes costs. In Malaysia, where diabetes prevalence has been rising steadily, the economic burden encompasses both the heavily subsidised public healthcare system and the out-of-pocket expenses borne by patients accessing private sector care. Subsequent research has estimated the total annual cost of diabetes to Malaysia at approximately RM 2.04 billion, with RM 1.40 billion incurred by the government through the public healthcare system.

Complications of diabetes, particularly nephropathy requiring haemodialysis, represent by far the most expensive component of diabetes care. End-stage renal disease management costs dwarf those of routine diabetes follow-up, underscoring the economic imperative for early detection and aggressive management of risk factors to prevent or delay complications.

Note: Malaysian cost figures from subsequent national cost analyses; presented for contextual comparison.

Challenges in Cost Assessment

The review identified several significant challenges in assessing the economic burden of diabetes in developing countries. The identification of both direct and indirect costs is inherently complex, as patients with diabetes frequently suffer from multiple complications and comorbidities that make cost attribution difficult. Costing methodologies vary widely across studies, limiting comparability. Data availability and quality remain significant constraints in many developing countries, where health information systems may be incomplete and out-of-pocket expenditure data scarce.

Policy Implications

The review concluded that the heavy economic burden of diabetes poses major challenges to health policymakers in developing countries in assessing their current approaches to managing this chronic disease. The authors recommended that serious efforts be directed toward focusing on and scaling up health promotion and diabetes prevention activities, which represent a more cost-effective solution compared to the reactive management of established disease and its complications.

In the Malaysian context, these recommendations have taken on increased urgency as national surveys have shown continuing rises in diabetes prevalence. The National Health and Morbidity Survey has documented that Malaysia has one of the highest diabetes prevalence rates in the Southeast Asian region, affecting approximately 17.5% of the adult population, with a substantial proportion remaining undiagnosed.

Limitations

As a narrative review, this paper did not employ systematic review methodology, and the selection of included studies was not based on a comprehensive, reproducible search strategy. The cost data presented were drawn from studies using diverse methodologies, currencies, and time periods, limiting direct comparability. The review focused primarily on published literature in English, which may not capture all relevant evidence from developing countries. Cost estimates presented reflect the economic conditions at the time of the original studies and may not reflect current healthcare costs.

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