Economic Burden of Diabetic Nephropathy in the Southwest of Iran
Abstract
Background: Diabetic nephropathy (DN) is a common complication of diabetes that, given the increasing prevalence of diabetes, imposes a serious economic burden on healthcare systems and societies. Therefore, this retrospective cross-sectional study aimed to estimate the economic burden of DN and identify factors influencing its cost in Iran.
Methods: Overall, 192 patients with DN were selected from Imam Khomeini and Golestan Hospitals in Ahvaz and then categorized into mild, moderate, and severe stages based on their glomerular filtration rate. Direct medical costs were obtained from hospital billing records, while non-medical and indirect costs were recorded through interviews with patients and their caregivers. Finally, the obtained data were analyzed by Microsoft Excel 2019 and Stata 16 using logistic regression models.
Results: The total cost of managing patients with DN was estimated at 839,083.88 PPP (current international dollars). Moreover, direct costs accounted for 88.2% of the total cost, of which 83.9% were medical, while 16.1% were non-medical. The logistic regression analysis demonstrated that education (odds ratio: 3.655, P = 0.044) and disability (odds ratio: 0.722, P < 0.001) were significantly associated with diabetes-related costs.
Conclusions: It was revealed that DN imposes a substantial economic burden on adults with type 2 diabetes. Thus, effective diabetes control and complication prevention strategies can help reduce these costs and alleviate the economic strain on both patients and the healthcare system.
1. Ahmad E, Lim S, Lamptey R, Webb DR, Davies MJ. Type 2 diabetes. Lancet. 2022;400(10365):1803-20. doi:10.1016/s0140-6736(22)01655-5.
2. Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi T. Diabetic kidney disease: world-wide difference of prevalence and risk factors. J Nephropharmacol. 2016;5(1):49-56.
3. Fain JA. National standards for diabetes self-management education and support: updated and revised 2012. Diabetes Educ. 2012;38(5):595. doi: 10.1177/0145721712460840.
4. Ong-Artborirak P, Seangpraw K, Boonyathee S, Auttama N, Winaiprasert P. Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities. BMC Geriatr. 2023;23(1):297. doi: 10.1186/s12877-023-04010-0.
5. Tripathy D, Chavez AO. Defects in insulin secretion and action in the pathogenesis of type 2 diabetes mellitus. Curr Diab Rep. 2010;10(3):184-91. doi: 10.1007/s11892-010-0115-5.
6. Hashim SA, Barakatun-Nisak MY, Abu Saad H, Ismail S, Hamdy O, Mansour AA. Association of health literacy and nutritional status assessment with glycemic control in adults with type 2 diabetes mellitus. Nutrients. 2020;12(10):3152. doi: 10.3390/nu12103152.
7. Roglic G. WHO Global report on diabetes: a summary. Int J Noncommun Dis. 2016;1(1):3-8. doi: 10.4103/2468-8827.184853.
8. Azadnajafabad S, Mohammadi E, Aminorroaya A, Fattahi N, Rezaei S, Haghshenas R, et al. Non-communicable diseases’ risk factors in Iran; a review of the present status and action plans. J Diabetes Metab Disord. 2021;23(2):1-9. doi: 10.1007/s40200-020-00709-8.
9. Gerstein HC, Sattar N, Rosenstock J, Ramasundarahettige C, Pratley R, Lopes RD, et al. Cardiovascular and renal outcomes with efpeglenatide in type 2 diabetes. N Engl J Med. 2021;385(10):896-907. doi: 10.1056/NEJMoa2108269.
10. Shamiri S, Pourasmail V, Najarzadeh Sam. Evaluation of the relationship between vitamin D, sodium and potassium
with nephropathy and its severity in patients with type 2 diabetes.2022;5(65):2008-2023.
11. Magee C, Grieve DJ, Watson CJ, Brazil DP. Diabetic nephropathy: a tangled web to unweave. Cardiovasc Drugs Ther. 2017;31(5-6):579-92. doi: 10.1007/s10557-017-6755-9.
12. Brugnara L, Novials A, Ortega R, De Rivas B. Clinical characteristics, complications and management of patients with type 2 diabetes with and without diabetic kidney disease (DKD): a comparison of data from a clinical database. Endocrinol Diabetes Nutr (Engl Ed).
2018;65(1):30-8. doi: 10.1016/j.endinu.2017.10.004. 13. Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML,
Zelmanovitz T. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care. 2005;28(1):164-76. doi: 10.2337/ diacare.28.1.164.
14. Bonakdaran S, Armanpour P. Evaluation of risk factors of renal involvement in patients with type 2 diabetes. Med J Mashhad Univ Med Sci. 2016;59(4):211-24. doi: 10.22038/mjms.2016.8481.
15. Al-Rubeaan K, Youssef AM, Subhani SN, Ahmad NA, Al-Sharqawi AH, Al-Mutlaq HM, et al. Diabetic nephropathy and its risk factors in a society with a type 2 diabetes epidemic: a Saudi National Diabetes Registry-based study. PLoS One. 2014;9(2):e88956. doi: 10.1371/journal.pone.0088956.
16. Lim A. Diabetic nephropathy - complications and treatment. Int J Nephrol Renovasc Dis. 2014;7:361-81. doi: 10.2147/ijnrd.S40172.
17. Samsu N. Diabetic nephropathy: challenges in pathogenesis, diagnosis, and treatment. Biomed Res Int. 2021;2021:1497449. doi: 10.1155/2021/1497449.
18. Tziomalos K, Athyros VG. Diabetic nephropathy: new risk factors and improvements in diagnosis. Rev Diabet Stud. 2015;12(1-2):110-8. doi: 10.1900/rds.2015.12.110.
19. John S. Complication in diabetic nephropathy. Diabetes Metab Syndr. 2016;10(4):247-9. doi: 10.1016/j.dsx.2016.06.005.
20. Leśniowska J, Schubert A, Wojna M, Skrzekowska-Baran I, Fedyna M. Costs of diabetes and its complications in Poland. Eur J Health Econ. 2014;15(6):653-60. doi: 10.1007/s10198-013-0513-0.
21. Helou N, Talhouedec D, Shaha M, Zanchi A. The impact of a multidisciplinary self-care management program on quality of life, self-care, adherence to anti-hypertensive therapy, glycemic control, and renal function in diabetic kidney disease: a cross-over study protocol. BMC Nephrol. 2016;17(1):88. doi: 10.1186/s12882-016-0279-6.
22. Wang V, Vilme H, Maciejewski ML, Boulware LE. The economic burden of chronic kidney disease and end-stage renal disease. Semin Nephrol. 2016;36(4):319-30. doi: 10.1016/j.semnephrol.2016.05.008.
23. Jose JV, Jose M, Devi P, Satish R. Pharmacoeconomic evaluation of diabetic nephropathic patients attending nephrology department in a tertiary care hospital. J Postgrad Med. 2017;63(1):24-8. doi: 10.4103/0022-3859.194199.
24. Karugu CH, Agyemang C, Ilboudo PG, Boachie MK, Mburu L, Wanjohi M, et al. The economic burden of type 2 diabetes on the public healthcare system in Kenya: a cost of illness study. BMC Health Serv Res. 2024;24(1):1228. doi: 10.1186/s12913-024-11700-x.
25. Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032-45. doi: 10.2215/cjn.11491116.
26. Nichols GA, Vupputuri S, Lau H. Medical care costs associated with progression of diabetic nephropathy. Diabetes Care. 2011;34(11):2374-8. doi: 10.2337/dc11-0475.
27. American Diabetes Association Professional Practice Committee. 11. Chronic kidney disease and risk management: standards of care in diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S219-30. doi: 10.2337/dc24-S011.
28. Yousefi M, Assari Arani A, Sahabi B, Kazemnejad A, Fazaeli S. Household health costs: direct, indirect and intangible. Iran J Public Health. 2014;43(2):202-9.
29. Su TT, Kouyaté B, Flessa S. Catastrophic household expenditure for health care in a low-income society: a study from Nouna district, Burkina Faso. Bull World Health Organ. 2006;84(1):21-7. doi: 10.2471/blt.05.023739.
30. Koye DN, Magliano DJ, Nelson RG, Pavkov ME. The global epidemiology of diabetes and kidney disease. Adv Chronic Kidney Dis. 2018;25(2):121-32. doi: 10.1053/j.ackd.2017.10.011.
31. Chen Y, Lee K, Ni Z, He JC. Diabetic kidney disease: challenges, advances, and opportunities. Kidney Dis (Basel). 2020;6(4):215-25. doi: 10.1159/000506634.
32. Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular
disease in chronic kidney disease: pathophysiological insights and therapeutic options. Circulation. 2021;143(11):1157-72. doi: 10.1161/circulationaha.120.050686.
33. Zoccali C, Mallamaci F, Adamczak M, de Oliveira RB, Massy ZA, Sarafidis P, et al. Cardiovascular complications in chronic kidney disease: a review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association. Cardiovasc Res. 2023;119(11):2017-32. doi: 10.1093/cvr/cvad083.
34. Gülümsek E, KeşkekŞ. Direct medical cost of nephropathy in patients with type 2 diabetes. Int Urol Nephrol. 2022;54(6):1383-9. doi: 10.1007/s11255-021-03012-4.
35. Zhou Z, Chaudhari P, Yang H, Fang AP, Zhao J, Law EH, et al. Healthcare resource use, costs, and disease progression associated with diabetic nephropathy in adults with type 2 diabetes: a retrospective observational study. Diabetes Ther. 2017;8(3):555-71. doi: 10.1007/s13300-017-0256-5.
36. Gordois A, Scuffham P, Shearer A, Oglesby A. The health care costs of diabetic nephropathy in the United States and the United Kingdom. J Diabetes Complications. 2004;18(1):18-26. doi: 10.1016/s1056-8727(03)00035-7.
37. Gandjour A, Armsen W, Wehmeyer W, Multmeier J, Tschulena U. Costs of patients with chronic kidney disease in Germany. PLoS One. 2020;15(4):e0231375. doi: 10.1371/journal.pone.0231375.
38. Prasad B, Osman M, Jafari M, Gordon L, Tangri N, Ferguson TW, et al. Kidney failure risk equation and cost of care in patients with chronic kidney disease. Clin J Am Soc Nephrol. 2022;17(1):17-26. doi: 10.2215/cjn.06770521.
39. McQueen RB, Farahbakhshian S, Bell KF, Nair KV, Saseen JJ. Economic burden of moderate chronic kidney disease in type 2 diabetes. Value Health. 2016;19(3):A14. doi: 10.1016/j.jval.2016.03.278.
40. Wyld ML, Lee CM, Zhuo X, White S, Shaw JE, Morton RL, et al. Cost to government and society of chronic kidney disease stage 1-5: a national cohort study. Intern Med J. 2015;45(7):741-7. doi: 10.1111/imj.12797.
41. Khan S, Amedia CA Jr. Economic burden of chronic kidney disease. J Eval Clin Pract. 2008;14(3):422-34. doi: 10.1111/j.1365-2753.2007.00883.x.
42. Zawudie AB, Daka DW, Teshome D, Ergiba MS. Economic burden of diabetic mellitus among patients on follow-up care in hospitals of Southwest Shewa Zone, Central Ethiopia. BMC Health Serv Res.2022;22(1):1398. doi: 10.1186/s12913-022-08819-0.
43. Aoun M, Helou E, Sleilaty G, Zeenny RM, Chelala D. Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives. BMC Health Serv Res. 2022;22(1):586. doi: 10.1186/s12913-022-07936-0.
44. Ahlawat R, Tiwari P, D’Cruz S. Cost of illness and the factors affecting it in the patients of chronic kidney disease at a public tertiary care hospital. Value Health. 2015;18(3):A187-8. doi: 10.1016/j. jval.2015.03.1086.
2. Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi T. Diabetic kidney disease: world-wide difference of prevalence and risk factors. J Nephropharmacol. 2016;5(1):49-56.
3. Fain JA. National standards for diabetes self-management education and support: updated and revised 2012. Diabetes Educ. 2012;38(5):595. doi: 10.1177/0145721712460840.
4. Ong-Artborirak P, Seangpraw K, Boonyathee S, Auttama N, Winaiprasert P. Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities. BMC Geriatr. 2023;23(1):297. doi: 10.1186/s12877-023-04010-0.
5. Tripathy D, Chavez AO. Defects in insulin secretion and action in the pathogenesis of type 2 diabetes mellitus. Curr Diab Rep. 2010;10(3):184-91. doi: 10.1007/s11892-010-0115-5.
6. Hashim SA, Barakatun-Nisak MY, Abu Saad H, Ismail S, Hamdy O, Mansour AA. Association of health literacy and nutritional status assessment with glycemic control in adults with type 2 diabetes mellitus. Nutrients. 2020;12(10):3152. doi: 10.3390/nu12103152.
7. Roglic G. WHO Global report on diabetes: a summary. Int J Noncommun Dis. 2016;1(1):3-8. doi: 10.4103/2468-8827.184853.
8. Azadnajafabad S, Mohammadi E, Aminorroaya A, Fattahi N, Rezaei S, Haghshenas R, et al. Non-communicable diseases’ risk factors in Iran; a review of the present status and action plans. J Diabetes Metab Disord. 2021;23(2):1-9. doi: 10.1007/s40200-020-00709-8.
9. Gerstein HC, Sattar N, Rosenstock J, Ramasundarahettige C, Pratley R, Lopes RD, et al. Cardiovascular and renal outcomes with efpeglenatide in type 2 diabetes. N Engl J Med. 2021;385(10):896-907. doi: 10.1056/NEJMoa2108269.
10. Shamiri S, Pourasmail V, Najarzadeh Sam. Evaluation of the relationship between vitamin D, sodium and potassium
with nephropathy and its severity in patients with type 2 diabetes.2022;5(65):2008-2023.
11. Magee C, Grieve DJ, Watson CJ, Brazil DP. Diabetic nephropathy: a tangled web to unweave. Cardiovasc Drugs Ther. 2017;31(5-6):579-92. doi: 10.1007/s10557-017-6755-9.
12. Brugnara L, Novials A, Ortega R, De Rivas B. Clinical characteristics, complications and management of patients with type 2 diabetes with and without diabetic kidney disease (DKD): a comparison of data from a clinical database. Endocrinol Diabetes Nutr (Engl Ed).
2018;65(1):30-8. doi: 10.1016/j.endinu.2017.10.004. 13. Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML,
Zelmanovitz T. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care. 2005;28(1):164-76. doi: 10.2337/ diacare.28.1.164.
14. Bonakdaran S, Armanpour P. Evaluation of risk factors of renal involvement in patients with type 2 diabetes. Med J Mashhad Univ Med Sci. 2016;59(4):211-24. doi: 10.22038/mjms.2016.8481.
15. Al-Rubeaan K, Youssef AM, Subhani SN, Ahmad NA, Al-Sharqawi AH, Al-Mutlaq HM, et al. Diabetic nephropathy and its risk factors in a society with a type 2 diabetes epidemic: a Saudi National Diabetes Registry-based study. PLoS One. 2014;9(2):e88956. doi: 10.1371/journal.pone.0088956.
16. Lim A. Diabetic nephropathy - complications and treatment. Int J Nephrol Renovasc Dis. 2014;7:361-81. doi: 10.2147/ijnrd.S40172.
17. Samsu N. Diabetic nephropathy: challenges in pathogenesis, diagnosis, and treatment. Biomed Res Int. 2021;2021:1497449. doi: 10.1155/2021/1497449.
18. Tziomalos K, Athyros VG. Diabetic nephropathy: new risk factors and improvements in diagnosis. Rev Diabet Stud. 2015;12(1-2):110-8. doi: 10.1900/rds.2015.12.110.
19. John S. Complication in diabetic nephropathy. Diabetes Metab Syndr. 2016;10(4):247-9. doi: 10.1016/j.dsx.2016.06.005.
20. Leśniowska J, Schubert A, Wojna M, Skrzekowska-Baran I, Fedyna M. Costs of diabetes and its complications in Poland. Eur J Health Econ. 2014;15(6):653-60. doi: 10.1007/s10198-013-0513-0.
21. Helou N, Talhouedec D, Shaha M, Zanchi A. The impact of a multidisciplinary self-care management program on quality of life, self-care, adherence to anti-hypertensive therapy, glycemic control, and renal function in diabetic kidney disease: a cross-over study protocol. BMC Nephrol. 2016;17(1):88. doi: 10.1186/s12882-016-0279-6.
22. Wang V, Vilme H, Maciejewski ML, Boulware LE. The economic burden of chronic kidney disease and end-stage renal disease. Semin Nephrol. 2016;36(4):319-30. doi: 10.1016/j.semnephrol.2016.05.008.
23. Jose JV, Jose M, Devi P, Satish R. Pharmacoeconomic evaluation of diabetic nephropathic patients attending nephrology department in a tertiary care hospital. J Postgrad Med. 2017;63(1):24-8. doi: 10.4103/0022-3859.194199.
24. Karugu CH, Agyemang C, Ilboudo PG, Boachie MK, Mburu L, Wanjohi M, et al. The economic burden of type 2 diabetes on the public healthcare system in Kenya: a cost of illness study. BMC Health Serv Res. 2024;24(1):1228. doi: 10.1186/s12913-024-11700-x.
25. Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032-45. doi: 10.2215/cjn.11491116.
26. Nichols GA, Vupputuri S, Lau H. Medical care costs associated with progression of diabetic nephropathy. Diabetes Care. 2011;34(11):2374-8. doi: 10.2337/dc11-0475.
27. American Diabetes Association Professional Practice Committee. 11. Chronic kidney disease and risk management: standards of care in diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S219-30. doi: 10.2337/dc24-S011.
28. Yousefi M, Assari Arani A, Sahabi B, Kazemnejad A, Fazaeli S. Household health costs: direct, indirect and intangible. Iran J Public Health. 2014;43(2):202-9.
29. Su TT, Kouyaté B, Flessa S. Catastrophic household expenditure for health care in a low-income society: a study from Nouna district, Burkina Faso. Bull World Health Organ. 2006;84(1):21-7. doi: 10.2471/blt.05.023739.
30. Koye DN, Magliano DJ, Nelson RG, Pavkov ME. The global epidemiology of diabetes and kidney disease. Adv Chronic Kidney Dis. 2018;25(2):121-32. doi: 10.1053/j.ackd.2017.10.011.
31. Chen Y, Lee K, Ni Z, He JC. Diabetic kidney disease: challenges, advances, and opportunities. Kidney Dis (Basel). 2020;6(4):215-25. doi: 10.1159/000506634.
32. Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular
disease in chronic kidney disease: pathophysiological insights and therapeutic options. Circulation. 2021;143(11):1157-72. doi: 10.1161/circulationaha.120.050686.
33. Zoccali C, Mallamaci F, Adamczak M, de Oliveira RB, Massy ZA, Sarafidis P, et al. Cardiovascular complications in chronic kidney disease: a review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association. Cardiovasc Res. 2023;119(11):2017-32. doi: 10.1093/cvr/cvad083.
34. Gülümsek E, KeşkekŞ. Direct medical cost of nephropathy in patients with type 2 diabetes. Int Urol Nephrol. 2022;54(6):1383-9. doi: 10.1007/s11255-021-03012-4.
35. Zhou Z, Chaudhari P, Yang H, Fang AP, Zhao J, Law EH, et al. Healthcare resource use, costs, and disease progression associated with diabetic nephropathy in adults with type 2 diabetes: a retrospective observational study. Diabetes Ther. 2017;8(3):555-71. doi: 10.1007/s13300-017-0256-5.
36. Gordois A, Scuffham P, Shearer A, Oglesby A. The health care costs of diabetic nephropathy in the United States and the United Kingdom. J Diabetes Complications. 2004;18(1):18-26. doi: 10.1016/s1056-8727(03)00035-7.
37. Gandjour A, Armsen W, Wehmeyer W, Multmeier J, Tschulena U. Costs of patients with chronic kidney disease in Germany. PLoS One. 2020;15(4):e0231375. doi: 10.1371/journal.pone.0231375.
38. Prasad B, Osman M, Jafari M, Gordon L, Tangri N, Ferguson TW, et al. Kidney failure risk equation and cost of care in patients with chronic kidney disease. Clin J Am Soc Nephrol. 2022;17(1):17-26. doi: 10.2215/cjn.06770521.
39. McQueen RB, Farahbakhshian S, Bell KF, Nair KV, Saseen JJ. Economic burden of moderate chronic kidney disease in type 2 diabetes. Value Health. 2016;19(3):A14. doi: 10.1016/j.jval.2016.03.278.
40. Wyld ML, Lee CM, Zhuo X, White S, Shaw JE, Morton RL, et al. Cost to government and society of chronic kidney disease stage 1-5: a national cohort study. Intern Med J. 2015;45(7):741-7. doi: 10.1111/imj.12797.
41. Khan S, Amedia CA Jr. Economic burden of chronic kidney disease. J Eval Clin Pract. 2008;14(3):422-34. doi: 10.1111/j.1365-2753.2007.00883.x.
42. Zawudie AB, Daka DW, Teshome D, Ergiba MS. Economic burden of diabetic mellitus among patients on follow-up care in hospitals of Southwest Shewa Zone, Central Ethiopia. BMC Health Serv Res.2022;22(1):1398. doi: 10.1186/s12913-022-08819-0.
43. Aoun M, Helou E, Sleilaty G, Zeenny RM, Chelala D. Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives. BMC Health Serv Res. 2022;22(1):586. doi: 10.1186/s12913-022-07936-0.
44. Ahlawat R, Tiwari P, D’Cruz S. Cost of illness and the factors affecting it in the patients of chronic kidney disease at a public tertiary care hospital. Value Health. 2015;18(3):A187-8. doi: 10.1016/j. jval.2015.03.1086.
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| Issue | Vol 9 No 4 (2025) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/htaa.v9i4.20667 | |
| Keywords | ||
| nephropathy diabetes cost of illness Economic burden | ||
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How to Cite
1.
Bagheri Faradonbeh S, Hayati F, Rashidi H, Torabipour A, Loveimi S. Economic Burden of Diabetic Nephropathy in the Southwest of Iran. Health Tech Ass Act. 2025;9(4).
