Out-of-pocket expenditure for diabetes mellitus and its determinants in recent times in India: A narrative review

Introduction: Diabetes is one of the major disease burdens in the world. Globally around 463 million people (at a prevalence of 9.3%) suffered from diabetes recently. Apart from morbidity and mortality, diabetes poses high economic burden on healthcare systems, especially on national economies in developing countries like India. Estimation of the cost burden of diabetes can help decision-makers to understand the magnitude of the problem, prioritize research efforts and interventions, and plan resource allocation, especially in resource-poor settings. The focus of our review was to summarize cost burden of diabetes and its determinants from existing literature in the last 10 years in India. Materials and Methods: All literatures published in the period 2010-2020 were accessed through two databases: PubMed and Google Scholar. Reference lists of the article were again searched for further literatures. Cost calculated in different times was converted to current price in 2020 for ease of comparison. Results: Studies reported a wide range of expenditures in different settings of care. Inequity of expenses across income quintiles among patients was found. Complication of diabetes, insulin therapy, treatment in private facility, and events of hospitalization were the factors associated to high expenditure burden. Conclusion: Financial risk protection for vulnerable people and control over medicine market price will reduce out-of-pocket expenditure for diabetes. Comprehensive strategy to delay onset of complication as well as its early detection can be an opportunity to cut down diabetes-related economic burden.