OBJECTIVES : The study evaluated the economic burden of T2DM including complications and co-morbidities and the risk of catastrophic health expenditures in a defined patient population.

METHODS. A prevalence-based cost-of-illness study design was adopted to evaluate the direct and indirect costs of managing T2DM patients in a teaching hospital setting. Data collection was based on non-interventional retrospective analysis of patient level data from medical records of diabetic patients as well as face-to-face interviews using semi-structured questionnaires. Bottom-up costing approach informed the identification and estimation of the total and average direct and indirect costs of treatment. Indirect costs estimate was on the basis of human capital approach. Catastrophic cost was measured from the non-food consumption expenditure of the respondents while socioeconomic status was measured by number of household items owned by respondents. Data were collected over a period of September 2016 and August 2017

RESULTS. Up to 359 diabetic outpatients were included in the study. The mean total cost (economic burden) of the disease per patient was N384,948.83 (US$1,099.85) per annum, comprising 86% (US$948.60) direct and 14% (US$ 151.30) indirect costs, at a monthly average of US$91.61 per diabetic outpatient (at the 2017 prices approx. N350 = US$1). Greatest proportion of the cost, 17% was spent on medications, followed by laboratory investigations (13%). The costs/burden increased with co-morbidities, complications, length of disease. Majority of patients (93%) relied on OOP expenditures to finance treatment with only 6% who are federal employee enrolees paid through insurance. Of the OOP patients, 9% paid through sales of properties, while on the whole up to 65% of the patients were subjected to the risk of catastrophic health expenditure at 40% threshold.

CONCLUSIONS. Finding suggest that diabetes imposes substantial economic burden on the Nigerian population subjecting a significant proportion of the low-income individuals and families to catastrophic health expenditures and financial impoverishment.