The burdens of type 1 diabetes provide the rationale for current discussions regarding disease prevention. These burdens include medical, social, psychological, and financial elements. Several studies on costs have noted a large financial burden related to diabetes (100), and the most current estimate in the United States places the annual medical and social costs of diabetes at $97 billion (101). Estimates focused solely on type 1 diabetes appear less frequently in the literature. Reports from England and
Wales (102), Israel (103), and Spain (104) note meaningful expenses in type 1 diabetes both in the short-term and on a lifetime basis.
Studies that describe the economic costs of diabetes often consider the direct or medical costs of the disease and, less frequently, the indirect costs of diabetes. Examples of indirect costs include the value assigned to morbidity, disability, and premature mortality associated with type 1 diabetes. From an economic perspective, the most important medical costs in type 1 diabetes include those related to the daily management of the disease and those related to the treatment of late-stage complications. The annual costs of treatment for type 1 diabetes have been shown to range between $1500 per person for standard (twice a day) insulin regimens, to $3000 for intensive regimens (multiple daily injections), and nearly $6000 for insulin pump protocols (105). Out-of-pocket health care costs for families with type 1 diabetic children in the United States exceed $1000 per year (106). The onset of complications generally leads to a marked increase in the use of hospital and outpatient services (107). The treatment of complications in England and Wales in 1992 accounted for one-half of the total medical costs of type 1 diabetes (102).
Estimating the economic value of the social costs of type 1 diabetes is often difficult. Several arguments exist over the most appropriate method to value human life. Several studies, though, note higher rates of disability and work-related absenteeism in persons with type 1 diabetes, particularly in those with late-stage complications (108-111). Together with higher rates of mortality, preliminary indications are that these indirect costs are larger than the direct costs of type 1 diabetes.
The impact of diabetes may also be felt in ways that are less easily quantifiable. The presence of type 1 diabetes, for example, is known to influence the insurance and employment experiences of affected individuals. Health, life, and sometimes automobile insurance are generally more difficult to obtain for a person with type 1 diabetes (106,112,113). Individuals may also face discrimination in the job application process (106,114) and often face limitations in the types of jobs available to them. Employment in commercial driving, for example, is limited out of concern for hypoglycemia (115).
Recent evidence suggests that the economic impact of type 1 diabetes does not affect all individuals equally. Financial barriers exist to appropriate implementation of diabetes management protocols. Individuals with inadequate health insurance coverage, for example, have been shown to test blood sugar levels less frequently (106,116) and have poorer levels of glycemic control (117). Out-of-pocket health care costs are also proportionately greater in the poor (112).
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