We have commissioned a study to estimate the cost of delivering diabetes care in the UK, and the findings have been published in the online journal Diabetic Medicine.
We worked with the York Health Economics Consortium to deliver the research and they have been supported by a steering group of experts, including healthcare professionals and people with lived experience of diabetes, full details below.
The study looked at how much the NHS spends on treating diabetes and diabetes complications, and also considered some of the indirect costs associated with the condition, including the costs of people unable to work and early mortality.
- Why look at the costs of diabetes?
- What type of research is this?
- There was a similar study in 2012 - why is it being carried out again?
- What's included in the research model?
- Costs for each nation and region
- Who helped inform the research?
- The findings
Why look at the costs of diabetes?
It is vital that we have up-to-date, high-quality evidence about diabetes care in the UK to inform our work with health systems and so that we can campaign for improvements at a national level. We share this information with health leaders and other decision-makers to help them to understand the current situation.
With 5.6 million people in the UK living with diabetes and millions more at high-risk of developing type 2 diabetes, caring for people with the condition is a significant part of the NHS’ work. This research helps us to understand where resources are currently being spent, so that we can see what is working well and where care could be improved.
What type of research is this?
The findings come from a cost of illness study, which means it summarises the costs of a particular health condition within the healthcare system and other institutions.
The costs are often divided into direct and indirect costs. Direct costs are those related to the healthcare system; things like diagnosis, treatment, management and handling of complications. Indirect costs represent the broader economic impact, for instance people being unable to work.
Approaches to cost of illness studies can vary a lot; there is not a single, set way to approach them, and methods will depend on what data is available and how it can be used.
This project looked primarily at direct costs and includes a small number of indirect costs. Estimates were made of the excess costs of diagnosis, treatment and diabetes-related complications compared with the general UK population. Estimates of the indirect costs of diabetes focused on productivity losses due to people being unable to work and premature mortality.
There was a similar study in 2012 – why is it being carried out again?
Much has changed in the 12 years since York Health Economics Consortium last studied the investment in diabetes care. The updated study aims to account for changes since then, such as to:
Demographics: a rising ageing population, increasing prevalence of diabetes, and increasing numbers of people at risk of developing type 2 diabetes.
Healthcare: Changes to diabetes management approaches and increased use of a wider range of medicines and diabetes technology have all developed over the previous decade, along with numerous other factors which may have impacted costs.
Availability of data: considering what data is available now, we are able to get a clearer idea of current costs by using a different methodology.
All costs modelling contains an inherent level of uncertainty – using the latest data and approaches helps us to be able to provide the most accurate results we can.
What is included in the research model?
We have made every effort to ensure the model is as comprehensive as possible, covering the costs of ongoing treatment and management for diabetes, and the costs of treating complications.
Estimated treatment and management costs include:
- diagnostic testing
- appointments (primary care consultations, foot clinics, retinal screening, dietary advice, secondary care consultations, psychological input for children),
- glucose control and diabetes medications and technology (consumables, monitoring devices and insulin pumps)
- blood pressure
- lipid levels
- antithrombotic therapies.
Additional appointments required during pregnancy were also accounted for.
The study also calculated the cost of diabetes-related complications, which were categorised into acute events, chronic macrovascular disease, microvascular disease and complications related to pregnancy. More detail on the calculations and sources used for prevalence and costs are set out in the Diabetic Medicine journal article and supplementary material.
The model also estimated some of the indirect costs of diabetes to the wider UK economy. There were limitations to the available information, but the costs of out-of-work sickness and early mortality were estimated to be £3.3 billion per year.
How have we worked out the costs for each nation and area?
UK health data is not uniform, and the nations comprising the UK have different approaches to data collection and publication. These create differences between what information is available and where.
To understand the costs across the UK, it has sometimes been necessary to apply figures and assumptions available in only one nation to the others. Equally, some assumptions about care provision are not available in published audit data, and needed to be sourced either from academic studies or expert input. These are standard procedures when modelling costs with imperfect data sources, and are clearly identified in the full study.
To estimate the costs for each local area, the costs model uses a ‘top-down’ approach, primarily due to what data is available and how it can best be used. This means that costs were sourced at a national level and applied to the local populations to obtain an overall estimate. Local estimates are then derived from these assumptions to give an idea of what costs may look like in a given area.
Who helped to inform the research?
The York Health Economics team were advised by a steering group chaired and convened by Diabetes UK and comprising diabetes clinical, policy and data experts, and experts with lived experience of diabetes. We would like to thank this group for their expert comments and suggestions.
Members of the steering group:
Helen O'Kelly, Assistant Director of Policy, Campaigns and Improvement, Diabetes UK (Chair)
Dr Marc Atkin, Consultant Diabetes & Endocrinology, Royal United Hospital Bath NHS Trust and Diabetes Clinical Lead, SWCVCN, NHS England
Hannah Beba, Consultant Pharmacist for Diabetes West Yorkshire Health and Care Partnership, Co-Chair Diabetes UK Health Care Professional Advisory Committee
Dr Naomi Holman, Research Fellow in Epidemiology and Intervention Effectiveness, School of Public Health, Imperial College London and Research Fellow, School of Population Health, Royal College of Surgeons in Ireland
Christine Leach, Person living with type 2 diabetes
Alistair Lumb, Diabetologist Oxford University Hospital
Carol Metcalfe, Advanced Specialist Practitioner, Paediatric Diabetes, Manchester
Kay Murray, Person living with type 2 diabetes
Hilary Nathan, Policy & Communications Director JDRF UK
Dr Paul M Newman, GP. Glasgow.
Nick Oliver, NW London/ Imperial
Joanne McKissick, Health and Social Care Northern Ireland
Sarah Wild, professor of epidemiology, University of Edinburgh and honorary consultant in public health, NHS Lothian and Public Health Scotland.
The findings
Where can people access cost estimates?
More detail is available here.
The costs do not seem to have risen much over the past decade compared to previous work– why is that?
There could be both substantive and methodological reasons behind differences in costs methods between projects. This work is not directly comparable to the 2012 study – it uses different data sources based on the most relevant and up to date data available. We must therefore be very cautious about drawing definitive conclusions based on differences or similarities between the two.
What does this mean?
How can the costs of diabetes be managed?
Around 60% of the money spent on treating diabetes is spent on treating complications, the majority of which could be prevented with the right care and support. Up front spending on education and support programmes, diabetes technology and new medications can help to avert these devastating complications, reducing NHS costs and enabling people to live well with diabetes.
However, to significantly reduce the harm and the cost from diabetes, the next government must also take ambitious action to reduce the number of people developing type 2 diabetes. Drastic changes to the environments we live in and the food we eat are taking a toll on our health. We need population-level interventions that put the building blocks of health in place for every child. So that everyone can afford a healthy diet; live in quality housing; and have access to green space and active travel routes.
What are you going to do with the findings?
We will use the findings to advocate for improvements to diabetes care and for national policies to help to reduce the rise in type 2 diabetes. In the short term, ahead of the general election, we will be calling on all parties to commit to work cross-departmentally to improve the public's health and take steps to shift spending from urgent care towards prevention, including the prevention of diabetes complications.
You can join us by emailing those standing for election where you live to ask them to make essential diabetes care a priority. It only takes a couple of minutes using our template email here.
In the longer term we will also explore with local health systems how they might use the model to better understand their local data, so that they can use it to inform new measures to reduce the harm, and associated costs, of diabetes.
What is the health system meant to do about this?
We work closely with leaders in health systems across the UK, including as a partner on the diabetes programmes. We will use the findings to support and amplify the work of the diabetes programmes, clinical leads and networks.
We will also explore with local health systems how they can use the model to help them to better understand their local data, so that they can use it to inform new measures to reduce the harm, and associated costs, of diabetes.
How can I get support?
Contact us on our helpline for more information and support.
