OBJECTIVES: Diabetes complications such as coronary heart disease pose a significant economic burden to health care systems and constitute a major part of the cost of diabetes. Studies have shown that health care utilisation and costs of diabetes complications are higher among older patient groups. The study ailms to systematically collate the available information on costs of major complications of type 2 diabetes in Australia, Canada, UK and USA.

METHODS: Published literature is searched in Medline, Embase, Cochrane, Scopus and EconLit to identify relevant English-language articles for the period 2005 to 2017. The review included studies that present monetary estimates on costs of one or more type 2 diabetes mellitus complications among adults 18 years and above. All costs are inflated to 2016 values using the health care component of consumer price indices in the respective countries and converted into 2016 international dollars (Int$) to facilitate comparability across countries, with information to enable translation into local currencies.

RESULTS: Studies on direct costs of type 2 diabetes complications, most of which were conducted from a health care payer perspective using cost data from administrative databases, were included. The annual direct medical cost of myocardial infarction associated with diabetes is Int$13,833, Int$9,875 and Int$17,193 per patient in Australia, UK and US, respectively. Stroke and amputation costs are Int$ 16,623 and 19,405 in Australia and Int$ 10,535 and 14,778 in UK, respectively. Australia and US spend Int$18,424 and Int$13,030 as direct medical cost of heart failure. Diabetic foot ulcer costs were Int$18,285, Int$17,145, Int$12,241 in Australia, Canada and US. Costs of nephropathy varied considerably ranging from Int$8,590 in US to Int$34,002 in Australia.

CONCLUSIONS: Despite variation in methodology and findings on estimated costs, all of the reviewed studies agree that costs of complications constitute a major part of the economic burden of diabetes.