Economic burden and cost of non-adherence in type 2 diabetes: a systematic review of middle- and high-income countries

Gómez-Torres, Piedad ; Blázquez-Ornat, Isabel Rosario (Universidad de Zaragoza) ; Lozano Del Hoyo, María Luisa (Universidad de Zaragoza) ; Samaniego-Díaz de Corcuera, Ma. Esther ; Ferrer-López, Emilia (Universidad de Zaragoza) ; Ramón-Arbués, Enrique ; Pérez-Calahorra, Sofía Pilar (Universidad de Zaragoza) ; Gómez-Barrera, Manuel ; Fernández-Rodrigo, Maria Teresa (Universidad de Zaragoza)

Resumen: Background: 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.

Idioma: Inglés

DOI: 10.1186/s13561-026-00755-7

Año: 2026

Publicado en: Health economics review 16 (2026), 50 [12 pp.]
ISSN: 2191-1991

Financiación: info:eu-repo/grantAgreement/ES/DGA/B53-23R

Tipo y forma: Review (Published version)

Área (Departamento): Área Enfermería (Dpto. Fisiatría y Enfermería)