A Comprehensive Analysis of the Financial Burden of Diabetes Mellitus at Rafik Hariri University Hospital: The Economic Implications from the Public Sector Perspective in Lebanon

Background and Aim: Diabetes Mellitus (DM) is a pandemic health problem with an unprecedented number of patients reaching hundreds of millions, and characterized by the vascular complications and premature mortality incurring a high cost of management. The aim of this study was to assess the economic burden of DM management and its complications in Beirut through comparing the hospitalization cost for patients with DM to that of patients not suffering from DM. Methods: Data were extracted from the electronic records of patients admitted to the largest public hospital in Beirut between January and March of 2009. Results: A total of 3626 patients with an average age of 45.9 years were admitted, of which 679 (18.7%) were suffering from DM according to the records. The prevalence of hospital re-admission was higher among patients with DM as compared to patients without DM. Moreover, the duration of stay in the hospital was almost twice as much among patient with DM as compared to patients without DM. The average cost of admission for patient with DM $2,804 was higher than that of patients not suffering from DM $1,641. Conclusion: Higher cost of hospitalization among patients with DM can be attributed to the lack of disease control which might have results in more complications. Public Health interventions should target patients and health care workers in order to improve the management of the disease and prevent complications and thus reduce cost. costs” (reduced labor force, absenteeism, chronic disability, premature death) but also owed to the intangible cost of the suffering and reduced quality of life of the patients, and their families [1]. Worldwide, the cost of DM management in 2013 as per the International Diabetes Federation (IDF) [2] is $548 billion with a mean expenditure of $1,436 in adults between 20 to 79 years of age. The estimated cost in the Middle East and North Africa (MENA) region was $14 billion with a mean expenditure of $684 in the same age group. This burden of DM management has been confirmed in several studies. Kirigia et al. (2009) [3] estimated the economic burden of DM in the countries of the World Health Organization (WHO) African Region to be $25.51 billion covering 7.02 million cases of DM in 2000. This is equivalent to an average of $3,633 per patient with huge direct costs (mainly due to insulin treatment) as well as indirect costs (manifested mainly by permanent disability). Analysis of medical expenditures in several countries showed that the costs of managing people with DM are substantially higher than those associated with non-DM individuals. This is due to the costs resulting from the increased likelihood of the development of further complications among DM patients [4]. The annual direct cost, to control the disease and to prevent chronic DM complications, paid by DM patients in Sudan, a lowincome country, was estimated to be around $175 including the cost of drugs and ambulatory care visits [5]. In Al-Ain City, United Arab Emirates (UAE), Al-Maskari et al. [6] estimated the mean direct annual treatment costs of DM management and its related complications to be $7,025 per Gulf Cooperation Council (GCC) patient compared to $5,645 per UAE patient and $4,304 per Asian patient. The presence of micro-vascular complications alone, macro-vascular complications alone, or both accounted to 2.2, 6.4, and 9.4 times higher annual treatment costs, respectively, than Background on the burden of Diabetes Mellitus Diabetes Mellitus (DM) imposes a pronounced socio-economic burden to any healthcare system [1]. This is not only owed to the tangible medical expenditure defined as “direct costs” (hospital inpatient care, ambulatory visits, medication.); and as “indirect