[Analysis of direct medical costs of type 2 diabetes in Mali]

Type 2 Diabetes (T2D) is rapidly increasing in Africa, but it is still rather neglected. Demonstrating the medical costs for treating type 2 diabetes would be useful for improving awareness and proposing solutions. The purpose of this study was to compare the estimated medical costs for basic chronic treatment and the actual expenditures of diabetic patients, and to identify determinants of these expenditures.

The estimated medical costs were based on price data collected from three public hospitals and their pharmacies (one university and two district hospitals), as well as from three private clinics and three private pharmacies, in Bamako. A standard treatment protocol for diabetes care, with and without complications, was first established by a working group prior to pricing of consultations, medication, care devices and specialized tests and treatments. Costs were computed using an Excel^® software program. We calculated actual expenditures for medical care and examined some determinants using the data from a cross-sectional survey on 500 adult diabetic subjects in Mali. Participants were randomly selected from registries of known diabetics.

The estimated costs for basic medical care of uncomplicated diabetes ranged from 108 to 298 € per year in the public sector, and 325 to 756 € in the private sector. Median annual expenditures of survey subjects without complications for chronic care amounted to 178 € (range: 98-331) and were therefore in the estimated range in the public sector. Total median expenditures of all survey subjects, including 78% with complications, reached 241 € per year (142-386). Additional expenditures for the treatment of complications were lower than the estimated costs, except for retinopathy. Independent predictors of higher expenditures were insulin treatment, residence in Bamako, and the number of complications. The minimum estimated cost of medical treatment for uncomplicated diabetes in the public sector represented 29% of GNP per capita. Total medical expenditures as reported by survey respondents amounted to an average of 24% of their income.

Treatment of T2D is expensive and beyond reach for many patients in Mali, particularly when there are complications. Prevention of diabetes is an urgent challenge in Africa, along with early screening in order to delay and reduce the occurrence of complications.