The Economic Cost of Type 2 Diabetes in Indonesia: A Systematic Review
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Abstract
Background: Type 2 diabetes (T2D) imposes a growing economic burden in Indonesia, driven by rising prevalence and associated complications. This review synthesizes current evidence on the economic costs of T2D in Indonesia to inform policy decisions aimed at alleviating these financial impacts.
Methods: A systematic review was conducted using the PRISMA guidelines and the PICOS framework, analyzing studies from major databases including PubMed, ProQuest, EBSCO, ScienceDirect, and Google Scholar published from 2019-2025. Studies included addressed both direct costs and/or indirect costs related to T2D in Indonesia, and reported annual or monthly per-patient costs.
Results: Six studies were included in the analysis, representing a diverse geographical coverage and various healthcare facilities, with the majority being tertiary facilities. The average annual direct cost per patient with complications reached USD 1,607.7, compared to USD 427.3 for patients without complications, a difference of 3.8 times. Limited indirect cost data show USD 35.2 for patients with complications versus USD 20.5 for cases without complications. Hospitalization, medications, and medical procedures are the main cost drivers. Only three studies reported indirect costs, indicating a potential underestimation of the total economic burden.
Conclusion: T2D complications increase healthcare costs by nearly four times. These findings support a shift in policy towards prevention, expansion of screening through insurance, and strengthening of primary services. Standardized methodologies and the inclusion of indirect costs are needed for more accurate study comparisons and policy guidance.
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28. Priyadi A, Permana H, Muhtadi A, et al (2021). Cost-Effectiveness Analysis of Type 2 Diabetes Mellitus (T2DM) Treatment in Patients with Complications of Kidney and Peripheral Vascular Diseases in Indonesia. Healthcare (Basel), 9(2):211.
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35. Wu H, Eggleston KN, Zhong J, et al (2018). How do type 2 diabetes mellitus (T2DM)-related complications and socioeconomic factors impact direct medical costs? A cross-sectional study in rural Southeast China. BMJ Open, 8(11):e020647.
36. Salman RA, AlSayyad AS, Ludwig C (2019). Type 2 diabetes and healthcare resource utilisation in the Kingdom of Bahrain. BMC Health Serv Res, 19(1):939.
37. Erzse A, Stacey N, Chola L, et al (2019). The direct medical cost of type 2 diabetes mellitus in South Africa: a cost of illness study. Glob Health Action, 12(1):1636611.
2. Kemenkes RI. Indonesia Health Profile 2023. 2024. [cited 2025 Jan 2]. Available from: https://kemkes.go.id/id/category-download/profil-kesehatan
3. Kemenkes RI. Riset Kesehatan Dasar 2018. 2018. [cited 2024 Oct 7]. Available from: https://layanandata.kemkes.go.id/katalog-data/riskesdas/ketersediaan-data/riskesdas-2018.
4. Kemenkes RI. Riset Kesehatan Dasar 2007. 2007. [cited 2024 Oct 7]. Available from: https://layanandata.kemkes.go.id/katalog-data/riskesdas/ketersediaan-data/riskesdas-2007.
5. Kemenkes RI. Riset Kesehatan Dasar 2013. 2013. [cited 2024 Oct 7]. Available from: https://layanandata.kemkes.go.id/katalog-data/riskesdas/ketersediaan-data/riskesdas-2013.
6. Coker T, Saxton J, Retat L, et al (2022). The future health and economic burden of obesity-attributable type 2 diabetes and liver disease among the working-age population in Saudi Arabia. PLoS One, 17(7):e0271108
7. Voeltz D, Vetterer M, Seidel-Jacobs E, et al (2024). Projecting the economic burden of type 1 and type 2 diabetes mellitus in Germany from 2010 until 2040. Popul Health Metr, 22(1):17
8. Abushanab D, Marquina C, Morton JI, et al (2023). Projecting the Health and Economic Burden of Cardiovascular Disease Among People with Type 2 Diabetes, 2022-2031. Pharmacoeconomics, 41(6):719-732.
9. Afroz A, Alam K, Ali L, et al (2019). Type 2 diabetes mellitus in Bangladesh: a prevalence based cost-of-illness study. BMC Health Serv Res, 19(1):601.
10. AlHarbi M, Othman A, Nahari AA, et al (2024). Burden of Illness of Type 2 Diabetes Mellitus in the Kingdom of Saudi Arabia: A Five-Year Longitudinal Study. Adv Ther, 41(3):1120-1150.
11. Baye TA, Gebeyehu H, Bekele M, et al (2024). The economic burden of hemodialysis and associated factors of among patients in private and public health facilities: a cross-sectional study in Addis Ababa, Ethiopia. Cost Eff Resour Alloc, 22(1):25.
12. Butt MD, Ong SC, Rafiq A, et al (2024). A systematic review of the economic burden of diabetes mellitus: contrasting perspectives from high and low middle-income countries. J Pharm Policy Pract, 17(1):2322107
13. Chong KS, Chang YH, Yang CT, et al (2024). Longitudinal economic burden of incident complications among metabolic syndrome populations. Cardiovasc Diabetol, 23(1):246
14. Çekin AH, Güner R, İnkaya AÇ, et al (2023). Modeling the Health Economic Burden of Hepatitis C Virus Infection in Turkey: Cost-Effectiveness of Targeted Screening. Turk J Gastroenterol, 34(10):1062-1070.
15. Frescos N, Stopher L, Jansen S, et al (2023). The financial burden of diabetes-related foot disease in Australia: a systematic review. J Foot Ankle Res, 16(1):92.
16. Kotsopoulos N, Connolly MP, Willis M, et al (2022). The public economic burden of suboptimal type 2 diabetes control upon taxpayers in Sweden: Looking beyond health costs. Diabetes Obes Metab, 24(6):1038-1046.
17. Parker ED, Lin J, Mahoney T, et al (2024). Economic Costs of Diabetes in the U.S. in 2022. Diabetes Care, 47(1):26-43.
18. Patel MR, Anthony Tolentino D, Smith A, et al (2023). Economic burden, financial stress, and cost-related coping among people with uncontrolled diabetes in the U.S. Prev Med Rep, 34:102246.
19. Pérez A, Redondo-Antón J, Romera I, et al (2024). Disease and Economic Burden of Poor Metabolic and Weight Control in Type 2 Diabetes in Spain: A Systematic Literature Review. Diabetes Ther, 15(2):325-341
20. Ganasegeran K, Hor CP, Jamil MFA, et al (2020). A Systematic Review of the Economic Burden of Type 2 Diabetes in Malaysia. Int J Environ Res Public Health, 17(16):5723.
21. König H, Rommel A, Baumert J, et al (2021). Excess costs of type 2 diabetes and their sociodemographic and clinical determinants: a cross-sectional study using data from the German Health Interview and Examination Survey for Adults (DEGS1). BMJ Open, 11(4):e043944.
22. Hidayat B, Ramadani RV, Rudijanto A, et al (2022). Direct Medical Cost of Type 2 Diabetes Mellitus and Its Associated Complications in Indonesia. Value Health Reg Issues, 28:82-89.
23. Sasongko MB, Wardhana FS, Febryanto GA, et al (2020). The estimated healthcare cost of diabetic retinopathy in Indonesia and its projection for 2025. Br J Ophthalmol, 104(4):487-492.
24. Drummond MF, Sculpher MJ, Claxton K, et al (2015). Methods for the economic evaluation of health care programmes. Oxford university press.
25. Haddaway NR, Page MJ, Pritchard CC, et al (2022). PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev, 18(2):e1230.
26. Kristina SA, Endarti DW, Andayani TM, et al (2020). Direct and Indirect Cost of Diabetes Mellitus in Indonesia: A Prevalence Based Study with Human Capital Approach. Int J Pharm Res, 13(1).
27. Putri RE, Darmawan E, Perwitasari DA (2019). Cost of illness diabetes melitus tipe 2 dan komplikasinya pada peserta jaminan kesehatan nasional (JKN) di rawat jalan rumah sakit condong catur yogyakarta. Pharmacon: Jurnal Farmasi Indonesia, 16(2):89-101.
28. Priyadi A, Permana H, Muhtadi A, et al (2021). Cost-Effectiveness Analysis of Type 2 Diabetes Mellitus (T2DM) Treatment in Patients with Complications of Kidney and Peripheral Vascular Diseases in Indonesia. Healthcare (Basel), 9(2):211.
29. Nita Y, Wardanasari DP, Cerelia DA, et al (2021). Cost of Illness Study of Type 2 Diabetes Mellitus in Indonesia. Int J Pharm Res, 13(1).
30. Diabetes Indonesia. Biaya Penanganan Diabetes di Indonesia Diproyeksikan Meningkat 33% pada 2045. 2021 [cited 2025 Jan 1]. https://dbindonesia.kebijakankesehatanindonesia.net/2022/05/biaya-penanganan-diabetes-di-indonesia-diproyeksikan-meningkat-33-pada-2045/
31. Prabowo S. Dua Faktor yang Memengaruhi Biaya Pengobatan Pasien BPJS Diabetes Mellitus. 2022 [cited 2025 Jan 1]. https://unair.ac.id/dua-faktor-yang-memengaruhi-biaya-pengobatan-pasien-bpjs-diabetes-mellitus/
32. Diabetes Indonesia. Perkembangan Klaim BPJS Kesehatan Nasional. 2024 [cited 2025 Jan 1]. https://dbindonesia.kebijakankesehatanindonesia.net/perkembangan-klaim-bpjs-kesehatan/
33. Birinci S, Sur H (2023). Cost of diabetes mellitus and related macrovascular complications in Turkiye. North Clin Istanb, 10(4):418-427.
34. Tuan Kiet Pham H, Tuyet Mai Kieu T, Duc Duong T, et al (2020). Direct medical costs of diabetes and its complications in Vietnam: A national health insurance database study. Diabetes Res Clin Pract, 162:108051.
35. Wu H, Eggleston KN, Zhong J, et al (2018). How do type 2 diabetes mellitus (T2DM)-related complications and socioeconomic factors impact direct medical costs? A cross-sectional study in rural Southeast China. BMJ Open, 8(11):e020647.
36. Salman RA, AlSayyad AS, Ludwig C (2019). Type 2 diabetes and healthcare resource utilisation in the Kingdom of Bahrain. BMC Health Serv Res, 19(1):939.
37. Erzse A, Stacey N, Chola L, et al (2019). The direct medical cost of type 2 diabetes mellitus in South Africa: a cost of illness study. Glob Health Action, 12(1):1636611.
| Files | ||
| Issue | Vol 54 No 10 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i10.20118 | |
| Keywords | ||
| Type 2 diabetes Economic cost Direct cost Indirect cost | ||
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How to Cite
1.
Adnan Y, Hadju V, Mallongi A, Ali M. The Economic Cost of Type 2 Diabetes in Indonesia: A Systematic Review. Iran J Public Health. 2025;54(10):2139-2150.
