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Prevalence of Diabetes and The Economic Impact in The Arab World: The Case of Jordan.

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Presentation on theme: "Prevalence of Diabetes and The Economic Impact in The Arab World: The Case of Jordan."— Presentation transcript:

1 Prevalence of Diabetes and The Economic Impact in The Arab World: The Case of Jordan

2 Algeria 21.0% (DM 13% + IGT 8%) Bahrain 40% DM (age >40 years) Egypt 20% (DM 10% + IGT 10%) (age >20 years) Morocco 24.2% (DM 15.7% + IGT 8.5%) Diabetes in Arab World

3 Sudan 19.4% (DM 10.4% + IGT 9.0%) Kuwait 22.0% (DM 20.0% + IGT 12.0%) Oman 19.0% (DM 10.0% + IGT9.0%) Qatar 30.0% (DM 10.0% + IGT 20.0%) Diabetes in Arab World

4 32.0% (DM 22.0% + IGT 10.0%) UAE 28.6% (DM 20.0% + IGT 8.6%) Egypt 22.6% (DM 12.6 % + IGT 10.0%) Tunisia 22.0 % (DM 13.1 % + IGT 9.0%) Lebanon Diabetes in Arab World

5 Saudi Arabia 40% (DM % + IGT %) (age >30 years) Arab Americans 41% (DM 18% + IGT 23%) (age >20 years) Jordan 23% (DM 13% + IGT 10%) (age >25 years) Diabetes in Arab World

6 Age DM Male%Female% * ** *P. <0.05 **P.<0.01 Arab Americans

7 Epidemiological studies of diabetes in Saudi Arabia, FBG: fasting blood glucose, OGTT: oral glucose tolerance RBG: random test, blood glucose. (M): male, (F): female.

8 prevalence of diabetes mellitus, hypertension, and high cholesterol among nationals in United Arab Emirates(N=8676) Variables n(%) DM Normal 3489(40.2) Impaired Fasting ( )3168(36.5) Frank DM(126+mg)2017(23.3) Hypertension(140/90) Negative6519(75.1) Positive 2157(24.9) Cholesterol Level Normal 7063(81.4) High (>240 mg) 1613(18.6) Body Mass Index < (24.2) (38.6) > (37.2)

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10 Normal RangePercentage %Disease 85/13537%Hypertension > % 17.3% Diabetes I mpaired Fasting Glucose <200 mg/dl mg/dl 40> mg/dl 100< 150< mg/dl 50.2% 27.9% % ؟؟؟ 43.6% Lipids Total Cholesterol High LDL Cholesterol Low HDL Cholesterol Triglyceride 25,0-29,9 > 30 42% 39.8% Overweight & Obesity (BMI) Overweight Obesity 30.5

11 جدول ( ) توزيع مجتمع الدراسة حسب حالة التدخين، الاردن 2007 Table ( ) Distribution of Study Population by Smoking Status, Jordan 2007 %No.حالة التدخينSmoking status مدخنون حالياCurrent Smokers مدخنون سابقونX Smokers لا يدخنونNon Smokers المجموعTotal

12 جدول( رقم3- 1) توزيع مجتمع الدراسة حسب مستوى السكر بالدم ( FBS) ( اعتمادا على الفحوصات المخبرية للسكري في الدم) / الأردن 2007 Table (3.1)Distribution of Study Population According to Fasting Blood Glucose Level (Based on Fasting Blood Glucose Readings), Jordan 2007 %عدد الأشخاص Number of Persons Fasting Blood Glucose Level مستوى السكر في الدم Normal Level مستوى الطبيعي Impaired Fasting Glucose السكري الكامن Diabetic Level السكري Total المجموع

13 جدول رقم 3-3 توزيع مجتمع الدراسه حسب مستوى السكر بالدم والفئات العمريه / الاردن 2007 Table (3.3) Distribution of the Study Population According to Fasting Blood Glucose Level and Age group (Based on Fasting Blood Glucose Readings), Jordan 2007 Total المجموع Diabetic Level السكري Impaired Fasting Glucose السكري الكامن Normal level مستوى طبيعي Age Group الفئات العمرية % *No% % % – – – – المجموع Total

14 جدول رقم 5-1 توزيع مجتمع الدراسة حسب معدل الكولسترول المرتفع الكثافة ( اعتمادا على الفحوصات المخبرية للكوليسترول الكلي) ، الأردن 2004 Table(5.1 )Distribution of Study Population According to Cholesterol DL-C Level(Based on Actual HDL-C Readings), Jordan 2004 % عدد الأشخاص Number of Persons Cholesterol HDL-C الكولسترول (المرتفع الكثافة) Low level مستوى منخفض High Level مستوى مرتفع Total المجموع

15 جدول رقم 5-1 توزيع مجتمع الدراسة حسب معدل الكولسترول المنخفض الكثافة في الدم (اعتمادا على الفحوصات المخبرية للكوليسترول المنخفض الكثافة) ، الأردن 2007 Table ( 5.1 )Distribution of Studu Population According to Cholesterol LDL-C ( (Based on Actual LDL-C Readings), Jordan 2007 % Number of Persons عدد الأشخاص Cholesterol LDL-C Level الكولسترول (المنخفض الكثافة) Optimal مستوى طبيعي Near or above optimal حول الطبيعي Borderline high ارتفاع طفيف High مرتفع Very High ارتفاع شديد Total المجموع

16 جدول رقم 6-1 توزيع مجتمع الدراسة حسب مستوى الشحوم الثلاثية في الدم (اعتمادا على نتائج الفحوصات المخبرية للشحوم الثلاثية في الدم) ، الأردن Table (6.1) Distribution of study Population According to Triglycerides Level (Based on Actual Blood Triglycerides Readings), Jordan 2007 % Number of Persons عدد الأشخاص Blood Triglycerides الشحوم الثلاثية في الدم) Optimal مستوى طبيعي Borderline high ارتفاع طفيف High مرتفع Very High ارتفاع شديد Total المجموع

17 جدول رقم 7-2توزيع مجتمع الدراسة حسب حسب معايير منظمة الصحة العالمية لمؤشر كتلة الجسم Table (7.2)Classification of study Population According to WHO Criteria Body Mass Index (BMI المجموع Total BMI Classification %No أقل من الوزن الطبيعي Under weight وزن طبيعي Normal weight زيادة الوزن Over weight سمنة من الدرجة الأولى Obesity Class I سمنة من الدرجة الثانية Obesity Class II سمنة من الدرجة الثالثة Obesity Class III المجموع Total

18 GDP per capita (JD) 1,515.6 Mean Family income = 5000 Jordan economics

19 جدول (( )) توزيع مجتمع الدراسة حسب دخل الاسرة الشهري من جميع مصادر الدخل، الاردن 2007 Table ( ) Distribution of Study Population by Monthly Income from all Sources, Jordan 2007 %No. Monthly Income in JD الدخل الشهري بالدينار < Don't know 0.725Refused رفض الأجابة Total المجموع

20 Affordability The best way of illustrating the impact of medicine prices on the cost of health care for individual and society is to compare the cost of treatment with people's actual incomes.

21 Affordability For the WHO/HAI survey, the daily wage of the lowest paid unskilled government worker in each country is used for comparison, and affordability is expressed as the number of days The lowest paid unskilled government worker would have to work in order to afford the cost of 30 days of treatment for the chronic condition being analysed.

22 Figure 3: Affordability of diabetes therapy with glibenclamide and metformin for 30 days (glibenclamide, 5 mg tablet twice a day + metformin 500 mg tablet three times a day expressed in days' wages of the lowest paid unskilled government worker to pay for treatment)

23 Figure1: Median price ratios (MPRs) of metformin 500 mg tablets

24 Figure 2: Median price ratios (MPRs), glibenclamide 5 mg tablets

25 Figure 4: Affordability of combination therapy with atenolol and hydrochlorothiazide – 30 days supply expressed in days’ wages of the lowest paid unskilled government worker, private sector retail pharmacies

26 Figure 1. Proportions of Total Expenditures on Prescription Drugs (Panel A) and of Total Prescriptions Dispensed (Panel B) Accounted for by Brand-Name Drugs and by Generic Drugs. Richard G et al, N Engl J Med 357;20 November 15, 2007

27 Figure 2. Change in the Average Relative Price of a Drug as the Number of Generic Versions Increases Richard G et al, N Engl J Med 357;20 November 15, 2007

28 Figure 2. Affordability of Treatment for Coronary Artery Disease in Six Low- or Middle- Income Countries. Robert Steinbrook, N Engl J Med 357;20 November 15, 2007

29 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) Glitazone (1X1) Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) The Price of most commonly used Agents for Diabetes at NCD- Jordan Oral Hypoglycemic Agents Case#1 Case#2 *Glitazone either Pioglitazone 30mg or Rosiglitazone 8mg.

30 30 Drug name Selling price (JD) /year Local drugImported drug Glitazone (1X1) Sulfonylurea8mg,2nd generation (1X1) Total Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) Sulfonylurea8mg,2nd generation (1X1) Total Case # 4 Case # 3

31 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) Sulfonylurea8mg,2nd generation (1X1) Long acting insulin analogues (30IU)/day*576 Total Oral Hypoglycemic Agents With Long acting insulin analogues *This preparation not available in the local company

32 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) Premixed insulin 30/70 (100IU)/day*239.4 Total Oral Hypoglycemic Agents With Premixed insulin 30/70 *This preparation not available in the local company

33 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) Premixed insulin analogues 30/70(100IU)/day*673.2 Total *This preparation not available in the local company Oral Hypoglycemic Agents With Premixed insulin analogues 30/70

34 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) Long acting insulin analogues(30IU)/day*576 Short acting insulin analogues(100IU)/day*204 Total Oral Hypoglycemic Agents With Long acting insulin analogues and Short acting insulin analogues *These preparations not available in the local company

35 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg(1X3) Glitazon (1X1) Sulfonylurea8mg,2ndgeneration (1X1) Aspirin(1X1) ACE-Inhibitors(1X2)* Total Oral Hypoglycemic Agents with ACE-Inhibitors * Average price of Enalapril20, Ramipril5mg, Perindopril4mg, and Fosinopril10mg.

36 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg(1X3) Glitazone (1X1) Sulfonylurea8mg,2nd generation (1X1) Aspirin(1X1) ARBs(1X1)* Total Oral Hypoglycemic Agents with ARBs * Average price of Valsartan160, Telmisartan80, and Candesartan16mg.

37 Drug name Selling price (JD) /year Local drugImported drug metformin 850mg (1X3) Glitazone (1X1) Sulfonylurea8mg,2nd generation (1X1) Aspirin(1X1) Statin(1X1)*54480 ARBs(1X1)** Total Oral Hypoglycemic Agents with ARBs and lipid Reducing Agents * Average price of Atrovastatin20mg, Simvastatin20mg, Rosuvastatin-10mg Pravastatin-40mg, and Fluvastatin80mg. ** Average price of Valsartan160, Telmisartan80, and Candesartan16mg.

38 Drug name Selling price (JD) /year Local drugImported drug metformin 850mg (1X3) Glitazone (1X1) Sulfonylurea8mg,2nd generation (1X1) Aspirin(1X1) Statin(1X1)*54480 ARBs(1X1)** Total Oral Hypoglycemic Agents with ARBs and lipid Reducing Agents *Average price of Atrovastatin20mg, Simvastatin20mg, Rosuvastatin-10mg Pravastatin-40mg, and Fluvastatin80mg. ** Average price of Valsartan160, Telmisartan80, and Candesartan16mg.

39 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) Glitazone (1X1) Sulfonylurea8mg,2nd generation (1X1) Aspirin(1X1) Statin(1X1)*54480 ARBs(1X1)** Beta blocker (1X1)***12192 Total Oral Hypoglycemic Agents with ARBs, Beta blocker and lipid Reducing Agents * Average price of Atrovastatin20mg, Simvastatin20mg, Rosuvastatin-10mg Pravastatin-40mg, and Fluvastatin80mg. **Average price of Valsartan160, Telmisartan80, and Candesartan16mg. ***Average price of Atenelol100mg, Bisoprolo10mg, Metoprolol100mg.

40 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) Glitazone (1X1) Sulfonylurea8mg,2nd generation (1X1) Aspirin(1X1) Statin(1X1)*54480 Gemfibrzil 600mg(1X2) ARBs(1X1)** Beta blocker (1X1)***12144 Calcium channel blocker (1X1)**** Total Oral Hypoglycemic Agents with ARBs, Beta blocker,Calcium -channel blocker and lipid Reducing Agents * Average price of Atrovastatin20mg, Simvastatin20mg, Rosuvastatin-10mg Pravastatin-40mg, and Fluvastatin80mg. **Average price of Valsartan160, Telmisartan80, and Candesartan16mg. ***Average price of Atenelol100mg, Bisoprolo10mg, Metoprolol100mg. **** Average price of Amilodipine10mg, Felodipine10mg.

41 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) Glitazone (1X1) Sulfonylurea8mg,2nd generation (1X1) Aspirin(1X1) Statin(1X1)54480 Gemfibrzil 600mg(1X2) ARBs(1X1) Beta blocker (1X1)12144 Calcium channel blocker (1X1) Ezetimibe10mg(1X1)* Total Oral Hypoglycemic Agents with ARBs, Beta blocker,Calcium - channel blocker and lipid Reducing Agents (Cholesterol& Triglyceride Reducers) * This preparation not available in the local company

42 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) Premixed insulin 30/70 (100IU)/day*239.4 Aspirin(1X1) Statin(1X1)54480 Gemfibrzil 600mg(1X2) ARBs(1X1) Beta blocker (1X1)12144 Calcium channel blocker (1X1) Ezetimibe10mg(1X1)* Total Oral Hypoglycemic Agents With Premixed insulin 30/70 And ARBs, Beta blocker,Calcium-channel blocker, lipid Reducing Agents (Cholesterol& Triglyceride Reducers) * These preparations not available in the local company

43 Drug name Selling price (JD) /year Local drugImported drug Metfomin 850mg (1X3) Glitazone (1X1) Sulfonylurea8mg,2nd generation (1X1) Aspirin(1X1) Statin(1X1)54480 Gemfibrzil 600mg ARBs(1X1) Beta blocker (1X1)12144 Calcium channel blocker (1X1) Ezetimibe10mg(1X1)* Ttotal Oral Hypoglycemic Agents with ARBs, Beta blocker,Calcium -channel blocker and lipid Reducing Agents (Cholesterol &Triglyceride Reducers) *This preparation not available in the local company

44 44 Drug name Selling price (JD) /year Local drugImported drug Metformin 850mg (1X3) Premixed insulin analogues 30/70(100IU)/day*673.2 Aspirin(1X1) Statin(1X1)54480 Gemfibrzil 600mg(1X2) ARBs(1X1) Beta blocker(1X1)12144 Calcium channel blocker (1X1) Ezetimibe10mg(1X1)* Total Oral Hypoglycemic Agents And Premixed insulin analogues 30/70 with ARBs, Beta blocker,Calcium-channel blocker, lipid Reducing Agents (Cholesterol & Triglyceride Reducers) *These preparations not available in the local company

45 Cost of Insulin Pump Medtronic MiniMed JD Medtronic MiniMed 722 (with glucose monitor) 3800JD Remote control 120 JD Monthly Cost: Insulin infusion set 90JD Reservoir 3ml 30JD Glucose sensor (optional) 150JD

46 Drug name Selling price (JD) /year Local drugImported drug Isosorbide dinitrate (1X2) Trimetazidine 20mg(1x2)*96 Alpha- AdrenoreceptorAntagonists(1X1)** Gabapentin(1X2) Antiglaucoma preparation (E/D)*240 Total Extra cost for diabetes complications at The Cardio-vascular, CNS, Genito Urinary system And Eye * These preparations not available in the local company **average price of Alfuzocin 10mg,Tamsulosin 0.4mg and doxazosin4mg.

47 Cost of Cardiac Procedures ECG10 Echo40 Stren40 Holter80 Adenosine scan NM350 Cath Stent Open heart surgery5000

48 Cost of Ophthalmic Procedures in JD Laser Therapy100 Cataract700 Intravitrial Injection200 Glaucoma500 Vitrectomy1000 Retinal detachment1000

49 Estimated annual cost of haemodialysis in Jordan, 2003(#1711) ItemCost (US$) Haemodialysis sessions Medications and investigations Admissions Arterial access Total Cost/ patient/ year

50 Prevalence of major Diabetes complications Dyslipidemia = 78% Hypertension = 73% Retinopathy = 34.1% Erectile dysfunction = 62%

51 Prevalence of the 4 most common chronic Diseases taken care by the center DiseaseJordan population above 25 year of age No. of patients Diabetes ,548 Hypertension ,804 Dyslipidemia ,693 Obesity+ Over Wt ,657,938

52 Diagnosed CasesAll Cases Medication Consultations 716 Labs 1224 Hospitalization Total *بموجب دراسة الدكتور علي مقداد من مركز مكافحة الأمراض الأمريكي 2004* Estimated cost of Diabetes, Hypertension and Dyslipidemia in Jordan by Dr. Makdady CDC U.S.A in JD

53 $ 132 Billion Total 42% Of Diabetes Costs Related To Hospitalization And Long-Term Care Direct Costs Indirect Costs 2002 US Total Healthcare Costs Attributable To Diabetes Diabetes Care,2003,26: Oral Antidiabeteic Insulin and Supplies Outpatient Medication Outpatient Services Physlcian Office Visits Inpatient Care(31%) Nursing Home Care(11%) Cost $ Billions تكلفة مرضى السكري في الولايات المتحدة الأمريكية

54 Direct cost ≈ Indirect cost (654 Million JD) ≈ (654 Million JD) Total ≈ 1,308 Billion JD Cost of Diabetics in Jordan

55 P=0.710 P=0.457 P=0.002 P< Women Men Age Group (Year) Percentage % P=0.071 Prevalence of Metabolic syndrome Among Jordanians Diabetes- Hypertension-Obesity-Dyslipidemia

56 السكري السكري هو السبب الأول في العمى ما بين الفئة العمرية السكري السكري هو السبب الأول في الفشل الكلوي السكري السكري مسؤول عن 60 % من حالات بتر الأطراف الغير مقرونة بالعنف السكري السكري يساوي في خطورته خطورة جلطة قلبية عند الذين لا يعانون من السكري الحقائق العشرعن السكري السكري السكري يساوي في خطورته خطورة جلطة دماغية عند الذين لا يعانون من السكري السكريين 75 % من حالات الوفاه عند السكريين سببها النهائي تصلب الشرايين والجلطات الدماغية السكري يتضاعف لدى الفئة العمرية ما بين سنة السكري يتضاعف لدى الفئة العمرية ما بين سنة السكري ينمو بتشخيص حالتين جديدتين كل 10 ثوان السكري ينمو بتشخيص حالتين جديدتين كل 10 ثوان السكري يصيب حوالي70000 طفل ممن هم دون سن 14سنوياً السكري يصيب حوالي طفل ممن هم دون سن 14سنوياً السكري السبب الرئيس في موت شخص واحد كل 10 ثوان السكري السبب الرئيس في موت شخص واحد كل 10 ثوان

57 Thank You


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