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COST OF DIABETES CARE IN URBAN AND RURAL SETTINGS OF BANGLADESH: A COMMUNITY BASED STUDYHasina Akhter Chowdhury1, Masuma Mannan1, Mithila Faruque2, Dilshad Ara Shopna1, Liaquat Ali11Pothikrit Institute of Health Studies, Bangladesh; 2Bangladesh University of Health Sciences, BangladeshEmail: hachowdhury01@gmail.comDiabetes imposes a large socioeconomic burden on the indi-vidual, family, and nation.Diabetes imposes a large socioeconomic burden on the indi-vidual, family, and nation.Diabetes imposes a large socioeconomic burden on the indi-vidual, family, and nation.BackgroundDiabetes mellitus imposes a large socioeconomic burden on the individual, family, and nation. The costs associated with the treatment of diabetes include an increased use of health services, loss of productivity, and disability. Primary evidence on these issues are scarce even in developed world and these are almost absent in the developing countries like Bangladesh. There are few data on direct and indirect costs of diabetes care in Bangladesh, but all of those are facility based and no community based study has so far been reported on costs of diabetes care in any Bangladeshi population.AimsThe present study was designed to estimate the costs of diabetes care and its components in urban and rural Bangladesh context with a community based approach.Methods and MaterialsUnder a cross-sectional analytical study was carried out on 1811 subjects (age 30 and above) with duration of diabetes minimum 01 year, in eight divisions of Bangladesh. The locations (with u2018villageu2019 in rural and u2018wardu2019 in urban areas as primary sampling unit) were selected using a multistage clustered sampling technique. Data were collected using validated interviewer-administered questionnaire and credible medical records. The cost of diabetes care (from consumer perspective) was recorded with breakdown in various components. Direct (consultancy, investigations, drugs and other related expenses) and indirect (lost productivity of the patients, lost productivity of the patients with attendants) costs were calculated on annual basis using standard procedures. Data were analyzed to determine the average cost (US$1 = Bangladeshi Taka 80) incurred by the diabetic patients in treating the disease and were calculated based on the total amount spent by them to that of total number of patients. Descriptive statistics will include mean (u00b1SD) and median (range) values for continuous data and relative frequencies (percentage) for categorical data. ResultsThe meanu00b1SD age of the patients was 50.73u00b111.86 years with duration of diabetes in urban 5.56 u00b1 4.7 yrs and in rural 5.88u00b15.3 yrs. The average annual cost of care was US$ 276 (Urban US$ 275 and rural US$ 270). The average direct cost was US$ 266 (Urban US$ 265 and rural US$ 261), and the indirect cost was US$ 10. The direct cost accounted for 96% and the indirect cost accounted for 4% of the total annual cost of care. Drugs accounted for the largest share (74%) of the direct cost, followed by laboratory investigations (12.5%) and consultation fees (4.6%). Excluding the unemployed persons, the average loss of productivity by the patients without and with attendants was US$ 4 and US$ 6 respectively. Among the components of direct cost, direct medical cost was higher (97%) than the direct nonmedical cost (3%). The indirect cost of care was 2.5 times higher for patients with attendants due to loss of productivity by attendants compared to patients without attendants.ConclusionsCost of diabetes case is fairly high in Bangladesh. Around three-fourth of the cost of care is used for drugs; deficient preventive education and advices as well as over prescription of medicines seem to be the major reasons for such high proportion of drug cost.Key WordsCost of diabetes care, Community based study, Bangladesh.
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