Health Economics and Diabetes in Egypt and

MENA Countries

Geographical distribution of the Egyptian Population

Agriculture 56%

Desert 1%

Urban 43%

30.5

20.5

14.3

13

9.3

6.3

6.1

0 5 10 15 20 25 30 35 %

ag

e g

ro

up

s

The pyramidal structure of the

Egyptian population

> 60

-60

-50

- 40

-30

-20

-10

0.62 0.80

3.08

8.25

12.04

15.06

0

2

4

6

8

10

12

14

16

% p

op

ula

tio

n

Prevelance of DM in whole Egypt in Different Age Groups

Age Group 20 30 40 50 60 >60

0

5

10

15

20

25P

erc

en

t

20 30 40 50 60 >60

Age

Diabetes Prevelance & Age Groups

National Economics and

Reflections on Health

• Gross National and Per capita income

• % Government and Household

expenditure on health

PARAMETERS

Gross Domestic Income / Capit Rank Country USD PP 2010 1 Qatar 179.000 2 Emirates 48.900 10 Kuwait 48.900 20 Bahrain 40.300 53 Oman 25.600 54 Saudi Arabia 24.200 80 Lebanon 14.400 81 Libya 14.700 103 Iran 10.600 112 Tunisia 9.400 135 Egypt 6.200 142 Jordan 5.400 149 Morocco 4.800 151 Syria 4.800 158 Iraq 3.800 171 Yemen 2.700 175 Pakistan 2.500 183 Sudan 2.300 214 Afghanistan 0.900

Gross Domestic Income / Capit Rank Country USD PP 2010 11 America 49.000 21 Holland 40.300 23 Sweden 39.100 29 Denmark 36.600 33 Germany 35.700 37 U.K. 34.800 38 Japan 34.000 39 France 33.100 42 Italy 30.500 45 Israel 29.800 47 Spain 29.400 63 Poland 18.800 69 Russia 15.900 124 China 7.600 132 Ukraine 6.700 174 Nigeria 2.500 181 Ghana 2.500 189 Senegal 1.900 202 Uganda 1.300 214 Afghanistan 0.900 222 Somalia 0.600

Gross Domestic Product / Country (BnUSD) Rank Country 2010 (Pop.) 1 Saudi Arabia 434 27.4 2 Iran 331 73.0 3 Emirates 297 07.5 4 Egypt 218 81.0 5 Pakistan 176 173.00 6 Algeria 159 35.00 7 Kuwait 109 2.70 8 Qatar 98 1.70 9 Morocco 90 30.00 10 Iraq 82 32.00 11 Sudan 62 43.50 11 Libya 62 6.40 12 Syria 59 20.50 13 Oman 46 02.70 14 Tunisia 44 10.50 15 Lebanon 39 04.20 16 Yemen 26 24.00 17 Bahrain 20 01.26 18 Afghanistan 17 34.00

Percent Health/ Government Expenditure in some European / American Countries USA ( 19%) Sweden ( 14%) France (16% ) Italy ( 14%) Spain (15 %) Germany ( 18%) Israel (10%)

Health Expenditure/Govent. Expend (per cent) MENA Countries

Qatar ( 7%) Emirates ( 9%) Kuwait ( 6%) Bahrain ( 11%) Lebanon (12%) Libya ( 6 %) Jordan (16%) Iran ( 9%) Algeria (11%) Tunisia (10%) Egypt ( 6%) Iraq ( 3%) Syria ( 5%) Yemen ( 3.6%) Afghanistan ( 4%) Pakistan ( 4%) Saudi Arabia ( 6% ) Oman ( 4.6% )

Morocco ( 5% )

GNI/per capit

< 5000 Very low

5000 -10000 Low

- 20000 Middle

- 40000 high

> 40.000 very high

Yemen 2700 Syria 4800 Morocco 4800 Pakistan 2500 Afghanist. 900

Egypt 6200 Tunis 9400 Jordan 5400

Lebanon 14400 Libya 14700 Iran 10600

Saudi 24000 Oman 25600

Qatar 179000 Emirates 48900 Kuwait 48900 Bahrain 40300

Health Expenditure per capit/year (USD)

E - 300 D - 500 C -1000 B - 3000 A > 3000

Syria 240 Morocco 240 Iraq 190 Pakistan 100 Afghan. 36 Sudan ?

Egypt 372 Yemen 315

Iran 954

Tunis 940 Libya 882 Jordan 864 Algeria ?

Lebanon 1728 Saudi A. 1452 Oman 1152

Qatar 12500 4400 Bahrain 4400 Emirate 2900 Kuwait

EGYPT

29.9%

Cost Burden of Oral Treatment related to Percapitum

QATAR

4.2%

8.4%

SAUDI ARABIA

8.85%

1.9%

QATAR

3.1%

SAUDI ARABIA

Year Cost / percapit. Burden for Human

Insulin (40 u /d)

Cost of DM in relation to funds available

DIRECT COST

OF TREATMENT

OF DM

L.E.235.2m

AVAILABLE

GOVERNMENT

EXPENDITURE ON

HEALTH

L.E. 351.8m

2/3!!

The Extra Burden of Cost of Treatment of

Complicated Diabetes at a Private Alexandria

Hospital, 2001 ( average of 100 diabetic patients ).

State of DMCost of oneday in USD

Relative Extraburden

DM (uncomplicated)

Admitted for glyceamic control

DM + C.V.D.

DM+ Renal Failure

DM + Diabetic foot

40.00

51.30

141.70

138.7

(100)

128%

354%

346%

Distribution of costs of Hospital Treatment of

Diabetic Patients ( L.E. per day ) at a Private Hospital

for Middle Class Egyptian Population at the City of

Alexandria , Egypt 2001

L.E. %

Cost of Medications and Medicalsupplies

99.00 55 %

Basic hospital expenses - Food - Health Care Team - All other running expenses

9.0019.8052.20

5 %11 %29 %

Average total cost per day 180 L.E. (= 40 $ ) 100 %

The different grades of daily and one year cost of simple oral medications for diabetes ( in Egyptian Pounds)

Per year/ person Per day / person Grades

135 - 495 0.37 - 1.36 I

328-584 438-627

0.90 - 1.60 1.20 - 1.72

II

1379 3.78 III

1825 5.00 IV

5840 7.85 - 8.00 V

From my personal clinical Practice Ninety percent ( 90%) of the fairly well controlled diabetes patients are managed by inexpensive oral medications - Metformin or Glibenclamide 20% - Metformin and Glibenclamide 50% - Metformin and Glimiperide 12% - Metformin and glyclazide 8%

70%

Example of extra cost of combined oral medication

Day cost

One tab cost .

Components = Metformin + Glibenclamide ( 500 mg) ( 5 mg)

155 266

42.5 …73.0

Uncombined ……… 12.5 Pt + 30 Pt Combined/tab X……………………………………

The cost is increased by 1.7 times for the same medication !!! “

Daily and one year cost of 40 U insulin at different price levels ( in Egyptian Pounds)

Per year Per person/day

450 1.24 Conventional Insulin

1435 3.93 New + Convent Insulin

2190 6.00 New Insulin

A Public Release by The University of

:)2008Oct 27 Chicago Medical Center ( THE COST OF DIABETES

TREATMENT NEARLY DOUBLED SINCE 2001

Because of increased number of patients growing reliance on multiple medications and the shift toward more expensive new medicines , the annual cost of diabetes drugs nearly doubled in only six years without an equivalent improvement in diabetes care outcome This finding raises important questions about whether the higher cost actually translates into improved care. The Archives of internal medicine

The single greatest contributor to increasing costs is the use of newer , more expensive medications……………….. “ but new drugs do not automatically lead to better outcomes “.

Just because a drug is new or exploits a new mechanism does not mean that it adds clinically to treating particular diseases . And even if a new drug does have a benefit , it is important to consider whether that benefit is in proportion to the increased cost . Stanford University School of Medicine

The average number of medications per patient has increased from 1.06 in 1994 to 1.45 in 2007.(36% more)

New drugs such as sitagliptin and exenatide cost 8 to 11 times more than older , generic drugs such as metformin or glypizide.

The price of insulin prescription increased as new and more expensive preparations of long-acting and ultrashort-acting insulins and their combinations gained popularity .

Short term outcomes like better A1c levels do not prove that patients with diabetes are actually benefiting from the new drugs in ways that matter .

term -correlate with longnot always may They outcomes that people really care about , such as diabetes impact on heart and kidney function .

term outcomes takes many -Important long

years to measure.

There is rapid uptake by physicians of newer and more expensive drugs whose long-term safety and cost-effectiveness in broader populations is not known ………………..

term data we can not be -“ without such long

certain if the widespread use of these more expensive drugs is balanced by sufficient improvements in health “.

Alexandrie – Palais du Montazah

Thank You

Middle East Countries- economic status

High Kuwait Emirates Qatar Bahrain Oman Saudi Arabia Libya

Low Syria Jordan Tunisia Morocco Egypt Yemen Sudan

Middle (Iraq) Iran

>5,000 US $ < 2,000 US $

>500 / year 100- 500 < 100 Kuwait 542

Iraq 573

Bahrain 641

Saudi Arabia 684

Lebanon 696

Emirates 761

Qatar 849

Egypt 138

Algeria 142

Morocco 166

Jordan 325

Iran 336

Libya 392

Oman 448

Tunisia 472

Afghanistan 9

Sudan 51

Yemen 70

Pakistan 76

Per Capit. Health Expenditures in EMME Countries

IDF Diab. Atlas 2003