The role of cost-effectiveness analysis and health insurance in diabetes care.

The theme of World Diabetes Day for 1999 is 'The Costs of Diabetes'. This theme was chosen quite purposely to reflect the broad nature in which diabetes affects individuals, families, and society. For the theme can highlight the importance of diabetes from a medical, social, or economic perspective. This presentation addresses two issues, cost-effectiveness analysis and financial barriers to care, that pertain to the economic viewpoint. Economically, the costs of diabetes are varied. They include items that one can easily recognize, such as the expenditures related to medical treatment for diabetes (direct costs) or the earnings lost to individuals prematurely disabled or dying young (indirect costs). Other less well known costs exists as well. These include the opportunity costs to individuals with diabetes who forego other 'opportunities in life' because they made a decision to devote their financial or time resources to diabetes care. They also include costs to society, such as the impact of using existing resources in diabetes care unwisely, or having inappropriate priorities. Cost-effectiveness analyses in diabetes care address this last point. Health insurance issues highlight one aspect of opportunity costs in diabetes care.