Gregory A. Nichols

Global healthcare expenditure on diabetes for 2010 and 2030

AIMS To estimate the global health expenditure on diabetes among people aged 20-79 years for the years 2010 and 2030. METHODS Country-by-country expenditures for 193 countries, expressed in United States Dollars (USD) and in International Dollars (ID), were estimated based on the countrys age-sex specific diabetes prevalence and population estimates, per capita health expenditures, and health expenditure ratios per person with and without diabetes. Diabetes prevalence was estimated from studies in 91 countries. Population estimates and health expenditures were from the United Nations and the World Health Organization. The health expenditure ratios were estimated based on utilization and cost data of a large health plan in the U.S. Diabetes expenditures for the year 2030 were projected by considering future changes in demographics and urbanization. RESULTS The global health expenditure on diabetes is expected to total at least USD 376 billion or ID 418 billion in 2010 and USD 490 billion or ID 561 billion in 2030. Globally, 12% of the health expenditures and USD 1330 (ID 1478) per person are anticipated to be spent on diabetes in 2010. The expenditure varies by region, age group, gender, and countrys income level. CONCLUSIONS Diabetes imposes an increasing economic burden on national health care systems worldwide. More prevention efforts are needed to reduce this burden. Meanwhile, the very low expenditures per capita in poor countries indicate that more resources are required to provide basic diabetes care in such settings.

Cost of Medical Care for Chronic Kidney Disease and Comorbidity among Enrollees in a Large HMO Population

Chronic kidney disease (CKD) afflicts up to 20 million people in the United States, but little is known about their health care costs. The authors analyzed costs and resource use associated with CKD by using National Kidney Foundation staging definitions. Patients insured through a large health maintenance organization with a laboratory finding of CKD (defined as estimated GFR between 15 and 90 ml/min per 1.73 m(2) in 1996 followed by a second GFR below 90 at the next creatinine measurement occurring at least 90 d later) were followed from 1996 for up to 66 mo. The final cohort included 13,796 persons with CKD and their age- and gender-matched controls; 1741 in stage 2; 11,278 in stage 3; and 777 in stage 4. Depending on stage, cases had 1.9 to 2.5 times more prescriptions, 1.3 to 1.9 times more outpatient visits, were 1.6 to 2.2 times more likely to have had an inpatient stay, and had 1.8 to 3.1 more stays than did controls. Total per patient follow-up costs were [

Independent contribution of diabetes to increased prevalence and incidence of atrial fibrillation.

total, (95% CI) cases and controls, respectively]

Older Women with Fractures: Patients Falling Through the Cracks of Guideline-Recommended Osteoporosis Screening and Treatment

38,764 (95% CI, 37,033 to

Replicating the chronic disease score (CDS) from automated pharmacy data

40,496) and

Weight change in diabetes and glycemic and blood pressure control

16,212 (95% CI,

Secondary Failure of Metformin Monotherapy in Clinical Practice

15,644 to

Normal Fasting Plasma Glucose and Risk of Type 2 Diabetes Diagnosis

16,780) in stage 2;

Health care utilization and costs by metabolic syndrome risk factors.

33,144 (95% CI,

The incidence of congestive heart failure associated with antidiabetic therapies

32,578 to