The Economic Costs of Type 2 Diabetes: A Global Systematic Review.
The Economic Costs of Type 2 Diabetes: A Global Systematic Review.
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DOI：
10.1007/s40273-015-0268-9
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发表时间：
2015-08
影响因子：
4.4
通讯作者：
Suhrcke M
中科院分区：
文献类型：
--
作者：
Seuring T;Archangelidi O;Suhrcke M
近几十年来，糖尿病患病率的增加已得到广泛记录和认可，不仅在高收入国家 (HIC)，而且在低收入和中等收入国家 (LMIC)。与糖尿病相关的经济负担，特别是在中低收入国家，尚不清楚。我们对 2 型糖尿病费用的全球证据进行了系统回顾。我们的综述旨在通过获取自 2001 年以来发表的有关全球 2 型糖尿病总体、直接和间接成本的证据，更新并大幅扩展之前对糖尿病成本的主要综述。此外，我们还纳入了迄今为止与疾病成本 (COI) 工作不同的经济证据，即关于糖尿病对劳动力市场影响的研究。我们检索了 PubMed、EMBASE、EconLit 和 IBSS（无语言限制），以查找 2001 年 1 月至 2014 年 10 月发表的评估 2 型糖尿病经济负担的研究。纳入研究中报告的成本已转换为根据 2011 年值调整后的国际美元 ($)。除了对研究进行叙述性综合和方法学审查之外，我们还进行了探索性线性回归分析，研究了国家之间和国家内部现有成本估算中存在相当大异质性背后的因素。我们确定了 86 项 COI 和 23 项劳动力市场研究。 COI 研究在方法和成本估算方面差异很大，尽管回归分析或匹配的使用有所增加，但大多数研究不使用对照组。直接成本通常高于间接成本。直接费用从墨西哥自付费用研究的 242 美元到美国糖尿病费用研究的 11,917 美元不等，间接费用从巴基斯坦的 45 美元到巴哈马的 16,914 美元不等。在中低收入国家（与高收入国家形成鲜明对比），很大一部分费用负担是由患者自付费用承担的。我们的回归分析显示，糖尿病的直接成本与一个国家的人均国内生产总值 (GDP) 密切相关，而且即使在控制人均 GDP 后，美国的成本也特别高。关于糖尿病对劳动力市场影响的研究几乎完全局限于高收入国家，并发现了严重的不利影响，特别是对男性就业机会的影响。其中许多研究还考虑了糖尿病可能的内生性，而 COI 研究则不然。审查的研究表明糖尿病造成巨大的经济负担，最直接影响中低收入国家的患者。国家之间和国家内部的成本估算规模差异很大，需要将研究结果具体化。增加中低收入国家糖尿病对劳动力市场影响的证据基础的范围仍然很大。此外，未来的 COI 研究需要在分析中纳入更先进的统计方法，以解释估计成本中可能存在的偏差。本文的在线版本 (doi:10.1007/s40273-015-0268-9) 包含补充材料，可供授权用户使用。
There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low- and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear. We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, i.e. studies on the labour market impact of diabetes. We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars ($) adjusted for 2011 values. Alongside the narrative synthesis and methodological review of the studies, we conduct an exploratory linear regression analysis, examining the factors behind the considerable heterogeneity in existing cost estimates between and within countries. We identified 86 COI and 23 labour market studies. COI studies varied considerably both in methods and in cost estimates, with most studies not using a control group, though the use of either regression analysis or matching has increased. Direct costs were generally found to be higher than indirect costs. Direct costs ranged from $242 for a study on out-of-pocket expenditures in Mexico to $11,917 for a study on the cost of diabetes in the USA, while indirect costs ranged from $45 for Pakistan to $16,914 for the Bahamas. In LMICs—in stark contrast to HICs—a substantial part of the cost burden was attributed to patients via out-of-pocket treatment costs. Our regression analysis revealed that direct diabetes costs are closely and positively associated with a country’s gross domestic product (GDP) per capita, and that the USA stood out as having particularly high costs, even after controlling for GDP per capita. Studies on the labour market impact of diabetes were almost exclusively confined to HICs and found strong adverse effects, particularly for male employment chances. Many of these studies also took into account the possible endogeneity of diabetes, which was not the case for COI studies. The reviewed studies indicate a large economic burden of diabetes, most directly affecting patients in LMICs. The magnitude of the cost estimates differs considerably between and within countries, calling for the contextualization of the study results. Scope remains large for adding to the evidence base on labour market effects of diabetes in LMICs. Further, there is a need for future COI studies to incorporate more advanced statistical methods in their analysis to account for possible biases in the estimated costs. The online version of this article (doi:10.1007/s40273-015-0268-9) contains supplementary material, which is available to authorized users.