title: The economic burden of diabetes in India: a review of the literature.
abstract: BACKGROUND
  Diabetes and its complications are a major cause of morbidity and mortality in India, and the prevalence of type 2 diabetes is on the rise. This calls for an assessment of the economic burden of the disease.
  
  
  OBJECTIVE
  To conduct a critical review of the literature on cost of illness studies of diabetes and its complications in India.
  
  
  METHODS
  A comprehensive literature review addressing the study objective was conducted. An extraction table and a scoring system to assess the quality of the studies reviewed were developed.
  
  
  RESULTS
  A total of nineteen articles from different regions of India met the study inclusion criteria. The third party payer perspective was the most common study design (17 articles) while fewer articles (n =2) reported on costs from a health system or societal perspective. All the articles included direct costs and only a few (n =4) provided estimates for indirect costs based on income loss for patients and carers. Drug costs proved to be a significant cost component in several studies (n =12). While middle and high-income groups had higher expenditure in absolute terms, costs constituted a higher proportion of income for the poor. The economic burden was highest among urban groups. The overall quality of the studies is low due to a number of methodological weaknesses. The most frequent epidemiological approach employed was the prevalence-based one (n =18) while costs were mainly estimated using a bottom up approach (n =15).
  
  
  CONCLUSIONS
  The body of literature on the costs of diabetes and its complications in India provides a fragmented picture that has mostly concentrated on the direct costs borne by individuals rather than the healthcare system. There is a need to develop a robust methodology to perform methodologically rigorous and transparent cost of illness studies to inform policy decisions.
authors.affiliation: School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India. yesudian@tiss.edu.
authors.forename: Charles A K
authors.initials: CA
authors.lastname: Yesudian
authors.affiliation: LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK. m.l.lundeby-grepstad@lse.ac.uk.
authors.forename: Mari
authors.initials: M
authors.lastname: Grepstad
authors.affiliation: LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK. e.visintin@lse.ac.uk.
authors.forename: Erica
authors.initials: E
authors.lastname: Visintin
authors.affiliation: LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK. a.ferrario@lse.ac.uk.|Social Policy Department, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK. a.ferrario@lse.ac.uk.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferrario
mesh_terms: D017281:Cost of Illness; D048909:Diabetes Complications / Q000191:economics* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000453:epidemiology; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D015995:Prevalence; D012959:Socioeconomic Factors