On the question for a socio-economic burden of type 1 diabetes in the Russian Federation

Background. Modeling of the socio-economic burden of diabetes mellitus type 1 (DM1T) in cohorts of children, adolescents, and adults was performed based on epidemiologic and calculated data for the first time in the local conditions. The specificity of the analysis is the calculation of the direct and indirect costs from social and government positions as well as the creation of the expenditure structure in each cohort of patients. Potential expenditures and their decreasing in patients 5–9 y. o. in case of illness delay have been evaluated on a 5‑year horizon.

Objective. The burden of DM1T evaluation in different cohorts divided by age and how it changes in the most sensitive group of patients (aged 5–9 y. o.).

Materials and methods Direct medical costs (DMC), indirect medical costs (IMC) and indirect costs (IC) in cohorts of kids (<15 y. o.), adolescents (15–18 y. o.) and adults were evaluated using the modeling method. DMC included: diagnostic and laboratory control, in- and out-patients’ treatment, rehabilitation, and treatment of complications. IMC was defined as the amount of pension payments due to early disability and benefits, means of individual mobility after amputation, payment for temporary disability due to hospitalization and outpatient treatment of disease and its complications, as well as for the care of a sick child of one parent. IC was defined as the loss of GDP. A total of 277 092 patients with DM1T were included in the analysis, 35 019 children and 13 012 adolescents. Diabetic nephropathy, retinopathy, neuropathy, diabetic ketoacidosis, amputation, myocardial infarction, stroke, cardiac insufficiency, and severe hypoglycemia as well as their costs have been taken into calculation.

Results. In the children’s cohort, expenditures were 256 762 RUR/pts, and insulin cost was 40%; in the adolescent’s cohort, — 293 611 RUR/pts, insulins — 102 907 RUR/pts; in adults, — 1 910 569 RUR/pts, and DMC — 17% (from all cost), IMC — 728 225 RUR/pts., (38%), IC — 861 179 RUR/pts. (45%). Total costs in the kids’ cohort — 9.28 bln RUR, in adolescents — 3,9 bln RUR, in adults — 438,5 bln RUR. Common burden was 451,6 bln RUR, DMC — 17,9%, 57,8 bln RUR from that is cost of complications. The cost of insulin therapy was only 4% of the total burden. DMC is prevalence in kids and adolescents’ cohorts, including cost of complications (20–26% from all direct cost), in the same time IMC (more — in adults) — 170,4 bln RUR. IC in kids and adolescents — 4–5% only from total burden, in adults — 197,6 bln RUR (45%). The burden is going to decrease by 13% already in the first year in case of delay of an DM1T onset, and on 62% in case of delay on 5 years.

Conclusion. DM1T is a socially significant disease, the burden of which is determined in the group of children and adolescents with DMC, in adults — by an increasing proportion of IMC and IC especially. Delaying the onset of the disease in children, even by 1 year, saves DMC of the budget.

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