Diabetes Dominates Primary Care Spending On NCDs

Diabetes made up about 45% of Malaysia’s RM9.65 billion direct health care costs from three chronic conditions (diabetes, cardiovascular disease, and cancer) in 2017.

KUALA LUMPUR, Dec 16 – Malaysia’s annual spending on primary care and outpatient attendance for diabetes is three times higher at RM3.1 billion than that for cardiovascular diseases (CVD) and cancer at RM1.03 billion and RM88.1 million respectively in 2017.

The RM3.1 billion spending on primary care and outpatient attendance for diabetes was also 221 per cent higher than hospitalisation cost for cancer at RM980.77 million and 210 per cent higher than hospitalisation cost for CVD at RM1.03 billion, according to 2017 data published in the “Direct Health-Care Cost of Noncommunicable Diseases (NCDs) in Malaysia” report by the Ministry of Health (MOH) and the World Health Organization (WHO).

Hospitalisations for diabetes are very low, accounting for only 6.73 per cent of the 350,788 total discharges in 2017 and 6.05 per cent of the RM2.12 billion discharge costs that year. 

It was noted in the report that many admissions for cardiovascular cases are likely to be a consequence of underlying diabetes hence, the hospitalisation data for diabetes may be under-represented.

Of the 23,617 discharges for diabetes, more than half (51.95 per cent) were attributed to type 2 diabetes and 6.94 per cent to type 1 diabetes. Another 33 per cent were due to renal dialysis that was directly attributable to diabetes. 

The average cost per hospital episode for diabetes was RM5,444.

The direct health care costs from the three NCDs in Malaysia exceed RM9.65 billion yearly, with diabetes making up about 45 per cent of the total at RM4.38 billion, followed by CVD (RM3.93 billion) and cancer (RM1.34 billion).

The largest components of the total annual direct health care costs across diabetes, CVD, and cancer were primary care and outpatient attendances that accounted for RM4.2 billion, or 43.5 per cent of the total cost, medications at RM1.72 billion (17.9 per cent), and medical tests at RM1.67 billion (17.3 per cent).

Biguanides Tops Medication Spending, While Diabetes Prevalence Remains High

On medications, CVD made up the highest cost among the three chronic conditions in 2017 at RM793 million, 52 per cent higher than diabetes (RM522.85 million) and 94 per cent higher than cancer (RM408 million).

Expenditure on diabetes drugs covers over 32 different medications. More than half (56.83 per cent) of the costs stemmed from three drugs, namely Biguanides, Sulfonylurea, and  biguanides and dipeptidyl peptidase-4 (DPP-4) inhibitors combined.

Different forms of insulin used in diabetes accounted for RM143.31 million, or 27.42 per cent of the total expenditure on diabetes medication.

Nearly 53 per cent of spending on diabetes drugs occurred in the private sector, in particular, through private pharmacies at about 24 per cent. Public sector clinics were responsible for 32.7 per cent of the expenditure.

The total estimated medicine utilisation in Malaysia in 2016 was reported at 632.32 defined daily dose (DDD) per 1,000 persons per day, with the public sector accounting for 63.8 per cent and the private sector 36.2 per cent.

Drugs used in diabetes were the most utilised therapeutic group at 73.27 DDD per 1,000 persons per day, followed by CVD drugs used, such as calcium channel blockers (69.04 DDD per 1,000 persons per day), agents acting on the renin-angiotensin system (50.68 DDD per 1,000 persons per day), and lipid modifying agents (36.6 DDD per 1,000 persons per day).

Drug utilisation figures expressed in DDDs are generally reported in units that control for population size differences, such as 1,000 persons. This provides a measure of exposure or therapeutic intensity in a defined population, allowing comparisons across various time periods and population groups.

Drug utilisation data presented in DDDs give a rough estimate of consumption and not an exact picture of the actual drug use.

In 2017, the total cost of medicines procured for all MOH hospitals, institutions and health clinics was RM 1.72 billion.

Haemoglobin A1c Test Forms Bulk Of Diabetes Test Expenditure

As for medical tests, CVD comprised the largest cost out of the three NCDs at nearly RM900 million, 701 per cent higher than cancer at RM112 million and 36 per cent higher than diabetes at RM661 million.

The MOH-WHO study excluded complex tests like echocardiogram and coronary angiogram from the medical tests component for CVD, as these were assumed to be performed as inpatient and captured in the hospitalisation costs. CVD refers to a number of conditions: heart disease, heart attack, stroke, heart failure, arrhythmia, and heart valve problems.

For diabetes, tests delivered to patients diagnosed with diabetes are designed to either monitor their diabetes or cholesterol readings, detect complications arising from the disease such as diabetic foot or diabetic retinopathy, or to check for cardiovascular comorbidities. 

Out of the 11 diabetes tests included in the report, the haemoglobin A1c test comprised the largest component of expenditure at RM137.02 million (20.72 per cent), followed by total cholesterol (8.9 per cent) and triglycerides (8.77 per cent). 

The haemoglobin A1c test is a commonly used blood test that measures your average blood sugar levels over the past three months. Higher A1c levels – above 5.7 per cent – are linked to diabetes complications.

A complete cholesterol test, also called a lipid panel or lipid profile, measures levels of cholesterol and other fats in the blood. 

According to the United States’ Centers for Disease Control and Prevention (CDC), having high levels of low-density lipoprotein (LDL) or “bad” cholesterol can lead to plaque buildup in the arteries, resulting in heart disease or stroke. 

In contrast, having high-density lipoprotein (HDL) or “good” cholesterol levels can lower the risk of heart disease and stroke.

A combination of high levels of triglycerides – a type of fat in the blood that is used for energy – with low HDL cholesterol or high LDL cholesterol levels can increase a person’s risk for heart attack and stroke.

Meanwhile, foot and eye examinations accounted for RM102.93 million (15.57 per cent) of all diabetes expenditure in Malaysia in 2017. Electrocardiograms also made up a sizable portion of diabetes test spending at RM66.39 million (10.04 per cent) as diabetes is a risk factor for heart disease. Patients with diabetes are regularly tested for CVD symptoms.

You may also like