The direct medical cost of type 2 diabetes mellitus in South Africa: a cost of illness study

Figures & data

Table 1. Overview of the study approach.

Study objective	To estimate the direct medical costs associated with T2DM in the South African public health sector
Target audience	Governments to prioritise T2DM investments
Grouping of direct costs	(1) T2DM control and (2) T2DM-related complications: renal disease, diabetic eye diseases, diabetic foot disorder, diabetic heart disease
Time frame	One year
Costing approach	Bottom-up approach
Calculating the total annual cost	TC = UC x Pop Total cost (TC) estimates for T2DM were calculated by multiplying the unit costs (UC) by the target population (Pop)

Table 2. Data categories and sources.

Data category	Parameter	Source
Population estimates	Population (15+) (n)	Statistics South Africa mid-year population estimates, 2018
Epidemiology parameters	Disease burden Medicine and technology need and usage Hospitalisation Outpatient visits	Literature review
Treatment coverage	Screened, diagnosed, treated, controlled cases	South African National Health and Nutrition Examination Survey (SANHANES-1, 2011–2012)
	Private/public sector divide	Council for Medical Schemes
Direct medical costs	Medication	South African National Health Laboratory Service
	Examinations and investigations	Uniform Patient Fee Schedule 2018
	Health workers wages	Department of Public Service and Administration

Table 3. Estimated annual incidence of T2DM-related conditions.

Indicators	Total number of new cases per year
T2DM-related blindness	12 614
T2DM-related amputation	3 311
T2DM-related stroke	11 037
T2DM-related ischemic heart disease	8 672

Table 4. Estimated direct medical health-care costs of T2DM in 2018, in thousands of South African Rand and US Dollars.

			Total annual cost
	Diagnosed T2DM cases (n = 240 447)			Diagnosed and undiagnosed T2DM cases (n = 3 106 321)
	(ZAR)	(USD)		(ZAR)	(USD)
Medication and equipment
Total annual cost of insulin	828 047	59 619		10 697 464	770 217
Total annual cost of syringes and needles	1 138	81		14 705	1 058
Total annual cost of glucose strips and lancets	4 635	333		59 885	4 311
Total annual cost of glucose meter and batteries	4 320	311		55 816	4 018
Total cost of oral drugs	96 739	6 965		1 249 763	89 983
Patient visit
Total cost of OPD consultation	47 608	3 427		615 051	44 283
Total cost of hospitalisation	99 437	7 159		1 284 619	92 492
Total cost of diabetes-related tests	338 340	24 360		4 370 987	314 711
Complications
Laser treatment for retinopathy and follow-up outpatient consultation	20 888	1 503		20 888	1 503
Treatment of cataracts	29 232	2 104		29 232	2 104
Amputation*	83 285	5 996		83 285	5 996
Stroke	383 226	27 592		383 226	27 592
Ischaemic heart disease	187 296	13 485		187 296	13 485
Renal imagining	182 505	13 140		2 357 772	169 759
Renal biopsy (per kidney)	429	30		429	30
Total annual cost of Haemodialysis	369 328	26 591		369 328	26 591
Total annual cost of Peritoneal Dialysis	61 065	4 396		61 065	4 396
Total cost of kidney transplant	18 129	1 305		18 129	1 305
Total cost of investigations	5 244	377		5 244	377
Total cost excluding complications	1 420 268	102 259		18 348 294	1 321 077
Total cost of complications	1 340 632	96 525		3 515 898	253 144
GRAND TOTAL	2 760 900	198 784		21 864 193	1 574 221

*including hospitalisation; below knee prosthesis.

Table 5. Total direct cost attributable to diagnosed T2DM in 2018, in thousands of South African Rand and US Dollars.

Resource category	Cost in thousands of South African Rand and US Dollars		% of annual total direct cost	% of South Africa`s annual healthcare budget
	(ZAR)	(USD)
Medication	924 787	66 584	33	0.52
Investigations	338 340	24 360	12	0.19
Hospitalisation	99 437	7 159	4	0.06
OPD consultations	476 086	3 427	2	0.03
Complications	1 340 623	96 525	49	0.75
TOTAL DIRECT COST	2 760 900	198 784	100	1.55

Table 6. Sensitivity analysis for annual T2DM costs in hundred thousands of South African Rand and US Dollars.

Variable		Medicine
Treatment and management of renal disease		−20%	0%	20%
	−20%	2 564 ZAR (174 USD)	2 633 ZAR (179 USD)	2 818 ZAR (191 USD)
	0%	2 575 ZAR (175 USD)	2 760 ZAR (187 USD)	2 945 ZAR (200 USD)
	20%	2 703 ZAR (183 USD)	2 888 ZAR (196 USD)	3 247 ZAR (220 USD)