ECONOMIC BURDEN OF TYPE 2 DIABETES MELLITUS IN INDIA: AN ANALYSIS OF HEALTHCARE RESOURCE UTILISATION, OUT-OF-POCKET EXPENDITURE, AND FUNCTIONAL OUTCOMES USING NATIONALLY REPRESENTATIVE SURVEY DATA
Author(s)
Rishabh Dev Pandey, PhD1, Prabhakar Pandey, M.Pharm, MBA2, Gurunag Kaushik, MSc3, Kandluru Sashank Reddy, MSc2.
1SEREXIA CONSULTANCY PVT LTD, BENGALURU, India, 2SEREXIA CONSULTANCY PVT LTD, Bangalore, India, 3SEREXIA CONSULTANCY PVT LTD, Bengaluru, India.
1SEREXIA CONSULTANCY PVT LTD, BENGALURU, India, 2SEREXIA CONSULTANCY PVT LTD, Bangalore, India, 3SEREXIA CONSULTANCY PVT LTD, Bengaluru, India.
OBJECTIVES: To quantify the economic burden, healthcare resource utilisation (HCRU), and functional burden of type 2 diabetes mellitus (T2DM) in India.
METHODS: Nationally representative data were drawn from the National Family Health Survey fifth round (NFHS-5, 2019-21), providing district-level random non-fasting capillary glucose elevation estimates across 37 states/union territories (UTs), and the Longitudinal Ageing Study in India Wave 1 (LASI, 2017-18) - a stratified survey of adults aged ≥45 years providing state-disaggregated healthcare resource utilisation (HCRU), out-of-pocket (OOP) expenditure, health financing, and functional status. HCRU comprised facility-stratified utilisation rates and expenditures. Functional burden was operationalised via poor self-rated health, activities of daily living/instrumental activities of daily living (ADL/IADL) limitation prevalence, and Composite International Diagnostic Interview-Short Form (CIDI-SF) depression. Direct national burden was extrapolated to 101 million cases (International Diabetes Federation [IDF] Atlas 2021); indirect costs applied the human capital approach (National Sample Survey Office wage referents).
RESULTS: NFHS-5 estimated national blood glucose elevation at 14.7% (capillary >140 mg/dL or pharmacological treatment), highest regionally in South India (20.2%). LASI estimated T2DM prevalence at 11.5%; Kerala (27.4%), Lakshadweep (22.8%), and Puducherry (22.4%) were highest. Mean national hospitalisation expenditure was ₹36,219, with a sixfold public-private differential (₹8,877 vs ₹52,022). Despite 26.2% household insurance coverage, 4.8% of hospitalisations were insurance-financed; 19.4% required loans or asset disinvestment. High-burden tertile states incurred 42% greater hospitalisation expenditure (₹34,648 vs ₹22,228). Poor self-rated health and ADL limitation correlated with state-level T2DM prevalence (r=0.40; r=0.37). Annual national burden totalled ₹1,302 billion (direct: ₹696 billion; indirect: ₹606 billion).
CONCLUSIONS: T2DM imposes a substantial, heterogeneous economic burden in India, characterised by catastrophic OOP expenditure, a marked public-private cost differential, underutilised insurance, and significant functional limitation, supporting health financing reform and stratified resource allocation toward high-burden states.
METHODS: Nationally representative data were drawn from the National Family Health Survey fifth round (NFHS-5, 2019-21), providing district-level random non-fasting capillary glucose elevation estimates across 37 states/union territories (UTs), and the Longitudinal Ageing Study in India Wave 1 (LASI, 2017-18) - a stratified survey of adults aged ≥45 years providing state-disaggregated healthcare resource utilisation (HCRU), out-of-pocket (OOP) expenditure, health financing, and functional status. HCRU comprised facility-stratified utilisation rates and expenditures. Functional burden was operationalised via poor self-rated health, activities of daily living/instrumental activities of daily living (ADL/IADL) limitation prevalence, and Composite International Diagnostic Interview-Short Form (CIDI-SF) depression. Direct national burden was extrapolated to 101 million cases (International Diabetes Federation [IDF] Atlas 2021); indirect costs applied the human capital approach (National Sample Survey Office wage referents).
RESULTS: NFHS-5 estimated national blood glucose elevation at 14.7% (capillary >140 mg/dL or pharmacological treatment), highest regionally in South India (20.2%). LASI estimated T2DM prevalence at 11.5%; Kerala (27.4%), Lakshadweep (22.8%), and Puducherry (22.4%) were highest. Mean national hospitalisation expenditure was ₹36,219, with a sixfold public-private differential (₹8,877 vs ₹52,022). Despite 26.2% household insurance coverage, 4.8% of hospitalisations were insurance-financed; 19.4% required loans or asset disinvestment. High-burden tertile states incurred 42% greater hospitalisation expenditure (₹34,648 vs ₹22,228). Poor self-rated health and ADL limitation correlated with state-level T2DM prevalence (r=0.40; r=0.37). Annual national burden totalled ₹1,302 billion (direct: ₹696 billion; indirect: ₹606 billion).
CONCLUSIONS: T2DM imposes a substantial, heterogeneous economic burden in India, characterised by catastrophic OOP expenditure, a marked public-private cost differential, underutilised insurance, and significant functional limitation, supporting health financing reform and stratified resource allocation toward high-burden states.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH7
Topic
Economic Evaluation, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Public Health
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)