Simple calculator to estimate the medical cost of diabetes in sub-Saharan Africa

Table 1 Care parameters for basic treatment of uncomplicated diabetes and for the treatment of chronic and acute complications

Medical conditions	Care component	Guidelines
Uncomplicated diabetes
	Consultation of diabetes specialist or a general practitioner	4/yr
	Fasting glucose test	4/yr
	Urine glucose test	6/yr
	Glycated hemoglobin	2/yr
	Proteinuria test	1/yr
	Blood lipid test TG, HDL-cholesterol, LDL-cholesterol	1/yr
	Electrocardiogram	1/yr
	Chest X-ray	1/yr
	Ophthalmology consult	1/yr
	Oral hypoglycemic agents
	Glibenclamide 5 mg OR in combination with metformin	3 tablets/d
	Metformin® 500 mg	3 tablets/d
	Glucophage® 850 mg OR in combination with Amarel®	3 tablets/d
	Amarel® 4 mg	1 tablet/d
	For insulin users
	Syringes	1/wk (min)-1/d (max)
	Insulin	30 UI (min) et 60 UI (max)/d
	Strips for blood glucose control	1 strip/d (min)
		3 strips/d (max)
	Glucometer	1 (Duration: 2 yr)
Chronic complications
Proliferative retinopathy
	Consultation in ophthalmology	3/yr
	Retinography	1/yr
	Laser photocoagulation	1/yr
Overt nephropathy
	Consultation in nephrology	2/yr
	Blood creatinine test	2/yr
	Serum protein test	2/yr
	Serum electrolytes test (sodium, potassium)	2/yr
	Urinary electrolytes test (sodium, potassium)	2/yr
	Urine creatinine test	2/yr
	Proteinuria	2/yr
	Hemogram	2/yr
	Urine bacteriology	4/yr
	Urine culture (ECBU)	1/yr
	Antiplatelet drugs
	Aspirin® 100 mg OR	1 tablet/d
	Plavix® 75 mg	1 tablet/d
	Antihypertensive (ARA2)
	Valsartan® 80 mg	1 tablet/d
	Diuretics:
	Laxilix® 40 mg OR	3 tablets/d
	Laxilix® special 500 mg	Half tablet/d
	Calcium carbonate (added to antiplatelet therapy, maximum cost)	2 tablets/d
	Statin (added to antiplatelet therapy, maximum cost)	1 tablet/d
Renal failure
	Dialysis	2 session/wk
	Potex® 4000 UI (EPO)	50 UI/kg weight (max)
		2 sessions/wk
	Calcium carbonate 500 mg	1.5 g or 3 tablets/d (max)
Ischemic heart disease
	Consultation in cardiology	2/an
	Antiplatelet drugs	See under nephropathy
	Statins
	Simvastatin (Zocor®) OR	1 tablet/d
	Atorvastatin (Tahor®)	1 tablet/d
	Exercise electrocardiogram testing	1/yr
	Echo doppler	1/yr
	Cardiac ultrasound	1/yr
	Coronarography	1/yr
Hypertension
	Consultation in cardiology	1/yr
	Antihypertensive drugs (ACEI)
	Captopril® 25 mg OU	3 tablets/d
	Ramipril® 5 mg	1 tablet/d
	Diuretics	See under nephropathy
	Aggregation inhibitors	See under nephropathy
	Semi quantitative urine protein test	2/yr
	Blood creatinine test	2/yr
	Proteinemia	2/yr
	Blood electrolytes test (Na, K, Ca)	2/an
	Stroke (chronic phase)
	Consultation in cardiology	2/yr
	Antiplatelet drugs	See under nephropathy
Diabetic foot
	Consultation in podiatry	1/yr
	Arteriography of the lower limbs	1/yr
	Physiotherapy sessions	10-20 sessions/yr
	Echo doppler	1/yr
	Statins	See under ischemic heart disease
	Antiplatelet drugs	1 tablet/d
	Orthopedic shoes	2 pairs/yr
Acute complications
Ketoacidosis
	Hospitalization	7 d
	Blood glucose test	Done once during hospitalization
	Glycated hemoglobin	Done once during hospitalization
	Hemogram	Done once during hospitalization
	Blood lipids test	Done once during hospitalization
	Blood electrolytes test (Na, K)	Done once during hospitalization
	Blood creatinine test	Done once during hospitalization
	Blood urea test	Done once during hospitalization
	Electrocardiogram	Done once during hospitalization
	Chest X- ray	Done once during hospitalization
	Echo doppler	Done once during hospitalization
	Keto-Diastix® box of 50 strips (blood biology)	3 times/d for 3 d
	Perfusion	3 d
Diabetic foot (acute)
	Hospitalization	90 d
	Antibiotics
	Oxaciline® 500 mg	4 tablets/d
		3 wk of treatment without bone involvement (min); 10 wk when bone involved (max)
	Vasodilator: Vastarel® 35 mg	2 tablets/d, 22 wk
	Biopsy	Done once during hospitalization
	Antibiogram	Done once during hospitalization
	Bone radiography	Done once during hospitalization
	Vascular ultrasound	Done once during hospitalization
	Dressings	1/wk, 22 wk
Foot surgery
	Minor surgery (56%)
	Major surgery, amputation (44%)
	Prosthesis
End stage renal disease
	Hospitalization	30 d
	Ultrasound	Done once during hospitalization
	Electrolytes blood test (Na, K)	Done once during hospitalization
	Creatinine blood test	Done once during hospitalization
	Proteinemia	Done once during hospitalization
Stroke
	Hospitalization	18 d
	Vasodilatator: Vastarel® 35 mg	2 tablets/d, 18 d
	Anticoagulants	1 tablet/d, 18 d
	Rehabilitation/physical therapy	18 d

TG: Triglycerides; HDL-cholesterol: High density lipoprotein cholesterol; LDL-cholesterol: Low density lipoprotein cholesterol; ARA2: Angiotensin receptor blocker; ACEI: Angiotensin converting enzyme inhibitors; EPO: Erythropoietin.

Table 2 Medical costs per individual per year for uncomplicated diabetes and for complications (in United States dollars) in the four countries

Medical condition	Bénin				Burkina Faso				Guinea				Mali
	Public sector		Private sector		Public sector		Private sector		Public sector		Private sector		Public sector		Private sector
	Min	Max	Min	Max	Min	Max	Min	Max	Min	Max	Min	Max	Min	Max	Min	Max
Uncomplicated diabetes	212	542	310	828	224	451	363	859	126	422	437	1093	137	335	390	869
Chronic complications - Basic medical cost for uncomplicated diabetes plus additional annual cost for single complication
Retinopathy	320	686	421	987	306	532	465	984	187	488	511	1243	177	374	524	1002
Stroke	233	576	672	1360	241	469	1644	2155	135	432	1267	1937	147	345	687	1850
Nephropathy	850	1920	1614	3198	783	1299	2578	3412	808	1578	2366	4256	491	1808	1516	4069
Hypertension	345	751	1256	2065	377	605	2074	2590	367	667	1784	2655	293	556	1212	2408
Ischemic heart disease	535	1297	1050	2188	496	785	1943	2577	313	612	1484	2553	441	1324	1002	2881
Diabetic foot	694	1533	1103	2386	923	1337	2447	4294	527	877	1717	3393	484	1424	1043	3172
Acute complications - Basic annual medical cost for uncomplicated diabetes plus additional cost per episode of acute complication
Keto acidosis	406	802	576	1297	387	665	1036	1936	222	531	726	1758	243	463	606	1391
Infected diabetic foot requiring hospitalization	728	1539	1020	3860	729	1702	6886	12043	667	1129	2897	6679	698	1340	1709	5802
Stroke (acute phase)	637	1117	834	1935	576	1064	2316	4147	510	933	1427	3315	455	705	1003	2266

Table 3 Diabetes medical costs and national income in the study countries (United States dollars)

Countries		Mali	Benin	Burkina Faso	Guinea
GNI per capita (2013)		670	790	670	460
% of population with < $2/d (= $730/yr)		78.7	74.3	72.6	72.7
Uncomplicated diabetes
	Minimum cost	137.21	211.63	224.42	125.58
	Maximum cost	868.60	827.91	859.30	1093.02
% of GNI (% of poverty threshold1)
	Minimum	20.5 (18.7)	26.8 (28.9)	33.5 (30.7)	27.3 (17.2)
	Maximum	129.6 (118.9)	104.8 (113.4)	128.3 (117.6)	237.6 (149.7)
Diabetes + retinopathy
	Minimum cost	176.74	320.93	305.81	187.21
	Maximum cost	1002.33	987.21	983.84	1243.02
% of GNI (% of poverty threshold)
	Minimum	26.4 (24.2)	40.6 (43.9)	45.6 (41.9)	46.8 (25.6)
	Maximum	149.6 (137.3)	125.0 (135.2)	141.6 (134.7)	270.2 (170.3)
Diabetes + nephropathy
	Minimum cost	490.70	850.00	782.56	808.14
	Maximum cost	4068.60	3197.67	3411.63	4256.98
% of GNI (% of poverty threshold)
	Minimum	73.2 (67.2)	107.6 (116.4)	116.8 (107.2)	175.7 (110.7)
	Maximum	607.3 (557.3)	404.8 (438.0)	509.2 (467.3)	925.4 (583.1)

¹Threshold of 2 dollars/d ($ 730/year) as set by the World Bank. GNI: Gross national income.