Cost of diabetes care in out-patient clinics of Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Diabetes Mellitus (DM) is a growing epidemic and the cost of treating diabetes is largely increasing. The objective of this study was to estimate the cost-of-illness of DM among attendees of out-patient clinics in Karachi, Pakistan. This is the first study conducted from a societal perspective to estimate the cost of managing diabetes in Pakistan.</p> <p>Methods</p> <p>A prevalence-based 'Cost-of-Illness' study for diabetes care was conducted in six different out-patient clinics of Karachi, Pakistan from July to September 2006. A pre-tested questionnaire was administered to collect the data from 345 randomly selected persons with diabetes.</p> <p>Results</p> <p>The annual mean direct cost for each person with diabetes was estimated to be Pakistani rupees 11,580 (US$ 197). Medicines accounted for the largest share of direct cost (46%), followed by laboratory investigations (32%). We found that increased age, the number of complications and longer duration of the disease significantly increase the burden of cost on society (p < 0.001). Comparing cost with family income it was found that the poorest segment of society is spending 18% of total family income on diabetes care.</p> <p>Conclusion</p> <p>This study concluded that substantial expenditure is incurred by people with diabetes; with the implication that resources could be saved by prevention, earlier detection and a reduction in diabetes co-morbidities and complications through improved diabetes care. Large scale and cost-effective prevention programs need to be initiated to maximise health gains and to reverse the advance of this epidemic.</p

Estimating cost of illness of diabetes mellitus in out-patient clinic setting of Karachi, Pakistan

Diabetes is becoming one of the major public health problems because of its rapid rise and a great proportion of the health care expenditure has been spent on the treatment of its associated morbidity and mortality. In every 10 seconds two people develop the disease and in same 10 seconds one person dies of diabetes related causes. Once diabetes develops, it is a costly disease to manage because of its chronic nature and severity of its complications. Chronic complications of diabetes include both macrovascular and microvascular complications. Managing diabetes alone can be costly and the costs associated with complications are far greater. Besides financial loss the human, social and economic costs of diabetes are also enormous. Cost analysis studies are scanty in developing countries including Pakistan. Thus we embarked with a study to estimate the direct and indirect cost of illness attributable to diabetes mellitus among attendees of out-patient clinics in Karachi, Pakistan. A pre-tested questionnaire was used to collect the data from total 345 persons with diabetes. Data was collected about their socio-demographic & clinical characteristics and cost of diabetes including consultation, investigations, medicine, travel, food and other costs. Indirect cost was calculated by using human capital approach. Cost for subsidized services was imputed using the average approximate of respective service. Minimum wage rates were used to calculate the income of housewives who were actively involved in home chores. Collected data was almost right skewed, therefore nonparametric tests were applied. We found that mean (SD) direct cost borne by person with diabetes and/ or his family is estimated to Rs. 1,930/- [SD 1385.318] for each visit. After adjustments, the monthly mean direct cost was Rs. 965. The mean (SD) indirect cost of patients and their attendants is estimated to Rs. [112.59 (284.91)] and [207.65 (497.91)] respectively. Hence, the total mean economic cost was Rs. 1,035/- per month. In this study, increasing age and number of complications due to diabetes elevate the burden of cost on society. From the total diabetes cost components cost for medicine takes the largest share (46%), followed by laboratory cost (32%). This study has underestimated the actual cost of diabetes care by excluding the hospitalization cost and other important economic indirect costs. Nevertheless, the derived cost is mind blowing and threatens to stunt economic growth and undermines the standard of living. The overall cost can be reduced by prevention of diabetes, earlier detection of disease and reduced diabetes co-morbidities and complications through improved diabetes care. Health care prevention and education are helpful tools to fight against diabetes. Prevention programs need to be initiated at larger scale to enhance health gain to the individual. People may be educated to adopt healthy lifestyle (alter diet, increase physical activity etc.) to reverse the advance of this epidemic. These prevention programs are extremely important for high risk population

Quit Smoking for Life-Social Marketing Strategy for Youth: A Case for Pakistan

Smoking is the single most avoidable risk factor for cancers. Majority of smokers know about this fact but it is difficult for them to give it up mainly in the face of widespread smoking advertisements by the tobacco industries. To reduce the prevalence of smoking and its associated cancers, immediate actions are required by public health authorities. Social marketing is an effective strategy to promote healthy attitudes and influence people to make real, sustained health behavior change by transiting through different stages which include precontemplation, contemplation, preparation, action, and maintenance. Social marketing can influence smokers to voluntarily accept, reject, modify, or abandon their smoking behavior. In Pakistan, the smoking prevalence has been increasing, necessitating effective measures. The trend of its usage has been going upwards and, according to the World Health Organization, in Pakistan, the usage of cigarette smoking is increased by 30% compared to 1998 figures. The Pakistan Pediatrics Association has estimated 1,000 to 1,200 school-going children between the ages of 6 and 16 years take up smoking every day. In Pakistan, ex-smokers in the low socioeconomic group reported spending 25% of the total household income on this habit. This paper focuses on the antismoking social marketing strategy in Pakistan with an aim to reduce smoking prevalence, especially among the youth

Role of self efficacy in promoting healthy behavior: Smoking cessation as an example

Self-efficacy is defined as an individual’s perceived capability to perform a behavior for accomplishment of a desirable goal. Enhanced personal self-efficacy is associated with a positive self-concept and self-appraisal of personal control which develops through experiences of mastery and the anticipation of competent performance. This paper aims to analyze the role of self-efficacy in promoting healthy behavior. A case scenario has been discussed to support the concept of self-efficacy in promoting healthy behavior taking smoking cessation as a case