000171277 001__ 171277
000171277 005__ 20260515163946.0
000171277 0247_ $$2doi$$a10.1186/s13561-026-00755-7
000171277 0248_ $$2sideral$$a149306
000171277 037__ $$aART-2026-149306
000171277 041__ $$aeng
000171277 100__ $$0(orcid)0000-0003-0045-7871$$aGómez-Torres, Piedad
000171277 245__ $$aEconomic burden and cost of non-adherence in type 2 diabetes: a systematic review of middle- and high-income countries
000171277 260__ $$c2026
000171277 5060_ $$aAccess copy available to the general public$$fUnrestricted
000171277 5203_ $$aBackground: Type 2 diabetes mellitus (T2DM) poses a growing economic burden in middle- and high-income countries due to its high prevalence and long-term complications. This study aimed to quantify and compare the annual per-capita direct and indirect costs of T2DM in adults of middle- and high-income countries, and to examine how treatment adherence relates to complications, hospitalizations, and costs, while also assessing the completeness of economic reporting. Main: A PRISMA-guided systematic review (January 2014—March 2024) searched MEDLINE (via PubMed), Embase, PsycINFO, and EconLit for adult studies reporting T2DM costs; reporting completeness was appraised with Consolidated Health Economic Evaluation Reporting Standards (CHEERS). All costs were standardized to annual per-person 2024 United States dollars (USD) adjusted for PPP (PPP-USD) using local Consumer Price Index (CPI) inflation and Purchasing Power Parity (PPP) conversion. When necessary, per-person values were derived from aggregated cost data. Fifteen studies met inclusion criteria. Direct costs varied widely, ranging from USD 17.74 per person-year in Pakistan to USD 623 in Spain, while indirect costs were reported in 5 of 15 (33.3%) studies and were highest in South Korea (USD 1,068) and China (USD 929.5), mainly from productivity losses and premature mortality. Higher adherence was associated with fewer complications and hospitalizations despite higher pharmacy spending, and adherence was frequently shaped by education, geographic context, and emotional distress. Conclusión: Beyond direct medical spending, the economic burden of T2DM is strongly influenced by indirect costs, especially productivity losses and premature mortality, which remain under-measured. Strengthening adherence and adopting standardized, societal-perspective costing with routine reporting of indirect costs, alongside near-term policy levers such as primary-care adherence support and targeted out-of-pocket relief, could improve comparability, equity, and efficiency by redirecting resources from avoidable hospitalizations toward sustained adherence support.
000171277 536__ $$9info:eu-repo/grantAgreement/ES/DGA/B53-23R
000171277 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc-nd$$uhttps://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
000171277 655_4 $$ainfo:eu-repo/semantics/review$$vinfo:eu-repo/semantics/publishedVersion
000171277 700__ $$0(orcid)0000-0002-8197-9884$$aBlázquez-Ornat, Isabel Rosario$$uUniversidad de Zaragoza
000171277 700__ $$0(orcid)0000-0003-2448-1630$$aLozano Del Hoyo, María Luisa$$uUniversidad de Zaragoza
000171277 700__ $$0(orcid)0000-0003-3699-3107$$aSamaniego-Díaz de Corcuera, Ma. Esther
000171277 700__ $$aFerrer-López, Emilia$$uUniversidad de Zaragoza
000171277 700__ $$0(orcid)0000-0002-7911-9949$$aRamón-Arbués, Enrique
000171277 700__ $$0(orcid)0000-0002-1894-1621$$aPérez-Calahorra, Sofía Pilar$$uUniversidad de Zaragoza
000171277 700__ $$aGómez-Barrera, Manuel
000171277 700__ $$0(orcid)0000-0002-6455-119X$$aFernández-Rodrigo, Maria Teresa$$uUniversidad de Zaragoza
000171277 7102_ $$11006$$2255$$aUniversidad de Zaragoza$$bDpto. Fisiatría y Enfermería$$cÁrea Enfermería
000171277 773__ $$g16 (2026), 50 [12 pp.]$$pHealth econ. rev.$$tHealth economics review$$x2191-1991
000171277 8564_ $$s1230272$$uhttps://zaguan.unizar.es/record/171277/files/texto_completo.pdf$$yVersión publicada
000171277 8564_ $$s2176703$$uhttps://zaguan.unizar.es/record/171277/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000171277 909CO $$ooai:zaguan.unizar.es:171277$$particulos$$pdriver
000171277 951__ $$a2026-05-15-14:56:32
000171277 980__ $$aARTICLE