Assessment of direct patient cost of managing diabetes mellitus at the Komfo Anokye Teaching Hospital, Kumasi Ashanti Region, Ghana

A diabetes mellitus epidemic is underway. According to American Diabetes Association (ADA) President, epidemiological studies predict that by the year 2002, there will be 250 -300 million individuals with diabetes mellitus. This will increase to at least 300 million by 2025. The number of deaths attributed to diabetes mellitus was previously estimated at just over 800,000. However, it has long been known that the number of deaths related to diabetes mellitus is considerably underestimated. There are 18.2 million people in the United States or 6.3% of the populations, who have been diagnosed with diabetes mellitus. Unfortunately, 5.2 million people in the USA (or nearly one-third) are unaware that they have the disease. According to the Ghana Diabetes Centre (GDC) in Accra, there are a total of 30,000 registered members and over 2,000 new cases are recorded annually as people diagnosed with the disease. This put the disease at a prevalence rate at 4.5% nationwide with Greater Accra Region alone placed at a prevalence rate of 6.3%, which shows that there is an epidemic of the disease in the region. This gives the proportion of the disease as follows: 2.1% among the 25-34 age group, 4.8% for the 35-44 age group, 8.5% for the 45-54 age group, 9.9 % for 55-64 years and 64 years and above at 13.6%. In this research sampling was done using probability sampling techniques. Both systematic and simple random sampling methods were used. Descriptive cross-sectional survey was used to collect data regarding the clinical characteristics, physical activity level, dietary habits, lifestyle and direct medical costs. This was successfully done by collecting and measuring all the 150 respondents with the aid of data collection tools such as the questionnaire and the weighing and height meter. Generally from the study, 30.7% had their FBS in the normal range due to correct usage of medication of which Metformin (70%) and Daonil (7 1.3%) were the most frequently prescribed hypoglycemic drugs. Hypertension-associated cardiovascular disease (44.0%) and hypertension alone (41.4%) were the commonest complications among the patients although few of them also had stroke (2.7%). From the research, the physical activity level was 63.3% among patients, who did one or more kinds of exercise. Walking was the commonest form of exercise (64.02%), followed by jogging (12.6%). Unfortunately, these exercises were mostly done for less than 30 minutes per day. It was not surprising that 36.0% of the patients had BMI between 26.0 - 30.0 kg/rn2. This study also estimated the annual direct medical cost of care for patients with Type II diabetes mellitus who visited KATH OPD 2004 as 33.0% of average annual income of patients. The annual cost per patient with Type II diabetes mellitus was estimated at ¢2,281,854.80, with the following breakdown: hospitalization (9.0%), ambulatory care (5.3%), anti-diabetic drugs (59.7%) and other complication drugs (22.4%). As expected, the costs of insulin per patient were higher for patients using insulin only or in combination with other medications. By comparing inpatients cost of hospitalization as ¢765,304.00, and outpatients as ¢205,500.00, it could be realized that the cost was higher among the inpatients than the outpatients. This could be as a result of recall bias in the case of the outpatients, which can also cause underestimation of the total cost incurred by patients. The findings of the study showed that direct costs increased markedly in patients with longstanding diabetes mellitus and, in particular, complications. Since this study was cross-sectional in nature and aimed at mapping the costs of current care, it was not designed to demonstrate or examine the cost effectiveness of interventions. However, the high costs of complications suggest that proactive intensive interventions to prevent complications may be worthwhile. Transportation costs to and from patient residence and the hospital was 3.5% of total cost of expenditure. The research on economic burden of diabetes mellitus is inadequate and more needs to be done in this area. Despite the limitations of the study, the results showed that diabetes mellitus imposed a very high economic burden on the individuals and society in Ghana as a whole. It is essential that researchers, individuals, institutions and organizations concerned intensify their efforts to research into prevention and control of the disease and educate the general public on healthy lifestyle through appropriate dietary and exercise in order to reduce the risk of obesity which is a predisposing factor to Type II diabetes mellitus.

Source: KNUST