Economic Burden of Diabetes Mellitus in Urban Population of Pakistan: A Cross-Sectional Analysis of Direct and Indirect Costs

Abstract

Background: Diabetes mellitus represents a rapidly growing public health challenge in Pakistan, with urban populations experiencing particularly high prevalence rates. The economic burden on individuals, families, and healthcare systems remains inadequately quantified, limiting evidence-based policy formulation. To comprehensively assess the direct and indirect economic costs associated with diabetes mellitus among urban populations in Pakistan.

Methods: A cross-sectional analysis was conducted across major healthcare facilities in Islamabad and Karachi involving 1,324 diagnosed diabetic patients recruited through systematic sampling. Direct costs included medical expenses (consultations, medications, laboratory tests, hospitalizations), while indirect costs encompassed productivity losses, transportation expenses, and caregiver time. Data collection utilized structured questionnaires, medical record reviews, and three-month cost diaries. Economic analysis was conducted from healthcare system and societal perspectives.

Results: Mean annual direct medical costs were PKR 89,750 per patient in Islamabad and PKR 76,340 in Karachi. Total annual costs including indirect expenses reached PKR 156,890 and PKR 134,220 respectively. Medications constituted 43.2% of direct costs, followed by monitoring and consultations (28.7%). Catastrophic health expenditure affected 52.8% of families in Islamabad and 58.3% in Karachi. Type 2 diabetes patients with complications incurred 2.3 times higher costs than those without complications. Lower-income families spent proportionally more household income on diabetes management (18.4% vs. 7.2%).

Conclusion: Diabetes mellitus imposes significant economic burden on urban Pakistani populations, with substantial costs disproportionately affecting lower-income families. High catastrophic health expenditure prevalence indicates inadequate financial protection mechanisms. Findings highlight urgent needs for comprehensive prevention programs, improved healthcare financing, and enhanced primary care services.