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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Simple calculator to estimate the medical cost of diabetes in sub-Saharan Africa
Koffi Alouki, Hélène Delisle, Stéphane Besançon, Naby Baldé, Assa Sidibé-Traoré, Joseph Drabo, François Djrolo, Jean-Claude Mbanya, Serge Halimi
Koffi Alouki, Hélène Delisle, Department of Nutrition, Faculty of Medicine, University of Montreal, Downtown Station, Montreal H3C 3J7, QC, Canada
Stéphane Besançon, Santé-Diabète (NGO), Mali Chapter, Bamako, Mali
Naby Baldé, Endocrinology Department, Donka Teaching Hospital, Conakry, Guinea
Assa Sidibé-Traoré, Internal Medicine Department, Bamako University Hospital, Bamako, Mali
Joseph Drabo, Internal Medicine Department, Ouagadougou University Hospital, Ouagadougou, Burkina Faso
François Djrolo, Endocrinology Department, National University Health Centre, Cotonou, Benin
Jean-Claude Mbanya, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
Serge Halimi, University Joseph Fourier and University Hospital Centre, 38043 Grenoble Cedex, France
Author contributions: Delisle H, Besançon S, Baldé N, Sidibé-Traoré A, Drabo J and Djrolo F designed the study; Alouki K, Delisle H, Besançon S, Baldé N, Sidibé-Traoré A, Drabo J and Djrolo F developed the calculator and collected the data; Mbanya JC and Halimi S advised on the methods; Alouki K and Delisle H analyzed the data; Alouki K and Delisle H drafted and finalized the manuscript; Besançon S, Baldé N, Sidibé-Traoré A, Drabo J, Djrolo F, Mbanya JC and Halimi S revised and corrected the manuscript.
Supported by The Canadian International Development Agency, Canada (Project DFN S064359); Koffi Alouki received a scholarship from the Islamic Development Bank for his PhD program in nutrition.
Institutional review board statement: As the study did not involve human subjects or animals, it did not require the review and approval of the Ethics Board of the Medical School, University of Montreal. Medical cost data were collected under the responsibility of hospital department heads in all four countries (members of the working group) and these professors of medicine have the required authority to collect and use the data. Furthermore, the identity of the hospitals and pharmacies where price information was collected was not divulgated. Additionally, the prices are known to the public and displayed in hospitals and pharmacies. Therefore, no further authorization or special permission to use the data was necessary.
Conflict-of-interest statement: None.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hélène Delisle, PhD, Professor Emeritus, Department of Nutrition, Faculty of Medicine, University of Montreal, PO Box 6128, Downtown Station, Montreal H3C 3J7, QC, Canada.
helene.delisle@umontreal.ca
Telephone: +1-514-3436111-25219 Fax: +1-514-3437395
Received: June 4, 2015
Peer-review started: June 6, 2015
First decision: June 18, 2015
Revised: August 27, 2015
Accepted: September 29, 2015
Article in press: September 30, 2015
Published online: November 25, 2015
Processing time: 172 Days and 5.8 Hours
AIM: To design a medical cost calculator and show that diabetes care is beyond reach of the majority particularly patients with complications.
METHODS: Out-of-pocket expenditures of patients for medical treatment of type-2 diabetes were estimated based on price data collected in Benin, Burkina Faso, Guinea and Mali. A detailed protocol for realistic medical care of diabetes and its complications in the African context was defined. Care components were based on existing guidelines, published data and clinical experience. Prices were obtained in public and private health facilities. The cost calculator used Excel. The cost for basic management of uncomplicated diabetes was calculated per person and per year. Incremental costs were also computed per annum for chronic complications and per episode for acute complications.
RESULTS: Wide variations of estimated care costs were observed among countries and between the public and private healthcare system. The minimum estimated cost for the treatment of uncomplicated diabetes (in the public sector) would amount to 21%-34% of the country’s gross national income per capita, 26%-47% in the presence of retinopathy, and above 70% for nephropathy, the most expensive complication.
CONCLUSION: The study provided objective evidence for the exorbitant medical cost of diabetes considering that no medical insurance is available in the study countries. Although the calculator only estimates the cost of inaction, it is innovative and of interest for several stakeholders.
Core tip: The costs of medical treatment of diabetes are poorly documented in sub-Saharan Africa, while such data are of interest for several stakeholders and useful for advocacy. There is a lack of tools to make these estimations. We describe a standardized, innovative and user-friendly medical cost calculator and provide the results of its use in four countries. It was developed in West-Africa but it is also relevant for other African countries and perhaps even in Asia provided the standard treatment protocol is deemed appropriate.
