Presentation (CTI)

OBJECTIVES: Health system performance for diagnosing and managing Type 1 diabetes (T1D) remains poor in many countries, and evidence is limited on the costs of scaling up essential T1D services. This study aimed to define standardized service packages for T1D care and to estimate the costs of scaling up these services for children and adolescents aged 0-20 years across countries globally.
METHODS: We used a two-stage approach. First, a Delphi consensus process with global clinical and health systems experts was conducted to define core and advanced T1D service packages, comprising over 30 individual services across diagnosis and outpatient management. Second, we applied a bottom-up micro-costing framework to estimate service delivery costs in 198 countries. Costs were estimated annually from 2025 to 2050, assuming 100% coverage among diagnosed individuals. Preliminary estimates were generated using retail prices and results were stratified by World Bank income group.
RESULTS: Insulin and glucose-monitoring services represented a substantial cost burden across all income groups. Median annual per-patient costs were higher in lower-income countries and increased under advanced service packages compared with core packages. Considerable cross-country variation in costs was observed. Aggregate annual costs to scale up insulin and monitoring services increased markedly over the projection period, indicating the scale of long-term financial commitments required to expand access for children and adolescents with T1D.
CONCLUSIONS: Scaling up insulin and glucose-monitoring services for T1D globally will require substantial and sustained investment, particularly in low- and middle-income countries. Full costing of comprehensive T1D service packages will further strengthen the evidence base to inform national and global financing strategies.