Al-Maskari et al. BMC Public Health 2010, 10:679 http://www.biomedcentral.com/1471-2458/10/679 R E S E A R C H A R T I C L E Open Access Assessment of the direct medical costs of diabetes mellitus and its complications in the United Arab Emirates Fatma Al-Maskari*, Mohammed El-Sadig, Nicholas Nagelkerke Abstract Background: Diabetes mellitus (DM) is a major health problem in the United Arab Emirates (UAE) and is well recognized as a major and increasing burden to the country’s resources due to its severe, long term debilitating effects on individuals, families and the society at large. The aim of the study was to estimate the direct annual treatment costs of DM and its related complications among patients in Al-Ain city, UAE. Methods: A sample of 150 DM patients were enrolled during 2004-2005, and their medical costs over the ensuing 12 months was measured, quantified, analyzed and extrapolated to the population in Al-Ain and UAE, using conventional and inference statistics. The costs were converted from UAE Dirhams to US Dollar, using the official conversion rate of US$ (1 USD = 3.68 AED). Results: The total annual direct treatment costs of DM among patients without complications in Al Ain-UAE, was US $1,605 (SD = 1,206) which is 3.2 times higher than the per capita expenditure for health care in the UAE (US$ 497) during 2004 (WHO, 2004). However, this cost increased 2.2 times with the presence of DM related complications for patients with microvascular complications, by 6.4 times for patients with macrovascular complications and 9.4 times for patients with both micro and macrovascular complications. Likewise, the annual direct hospitalization costs of DM patients increased by 3.7 times for patients with microvascular complications, by 6.6 times for patients with macrovascular complications and by 5 times for patients with both micro and macrovascualr complications. Overall, costs increased with age, diabetes duration and were higher for patients treated with insulin compared to those treated with oral hypoglycemic agents or with diet control only. Conclusions: DM direct treatment costs increased with the presence and progression of chronic DM related complications. Hospitalisation costs constituted a large proportion and were increasingly higher with the presence and progression of DM related complications. To reduce the impact on healthcare resources, efforts should be made to prevent progression to DM complications, by implementing guidelines for diabetes care, screening for complications and better management. Background Diabetes Mellitus (DM) is a major cause of morbidity, disability and mortality worldwide [1]. In addition, the economic burden on patients and society in the form of direct and indirect costs is enormous [1]. The IDF pro- jections show that the health care expenditures on dia- betes will account for 11.6% of the total healthcare expenditure in the world in 2010 [1]. A recent study in * Correspondence: fatma.am@uaeu.ac.ae Department of Community Medicine, Faculty of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, P.O. Box: 17666, United Arab Emirates the U.S. estimated that annual costs in 2007 exceeded US $174 billion [2]. A similar study in Italy showed that the direct costs of healthcare in 2006 were €2,589 per DM patient, compared to €1,682 for matched people without diabetes [3]. In Europe, the CODE-2 study showed that more than 10 million people with type 2 diabetes across eight European countries cost over EUR 29 billion in 1999 M [4]. The prevalence of diabetes in the United Arab Emi- rates (UAE) is reportedly among the highest in the world [1]. A population survey in Al Ain, UAE, in 2000 estimated the prevalence of DM at 25% among nationals © 2010 Al-Maskari et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.