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Epidemic could cost Manitoba $639M a year by 2020

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It's not just a health crisis; it's an economic nightmare.

The soaring epidemic of Type 2 diabetes, Canada's fastest-growing chronic disease, is already draining millions of dollars from government coffers, and the annual bill is expected to skyrocket over the next 10 years.

"This diabetes storm will not only threaten the health and prosperity of tens of thousands of Manitobans, but will also challenge the sustainability of the health-care system and the overall prosperity of the province," Michael Cloutier, president of the Canadian Diabetes Association, warned MLAs at a special forum in February.

In what he called a "frank warning" for the province, Cloutier noted Manitoba, which already has the highest rate of diabetes on the Prairies, is looking at a 48 per cent jump in the number of people living with the potentially deadly disease -- to 139,000 from 94,000 -- by the end of the decade.

That soaring human toll means the amount the disease costs Manitoba, if left unchecked, is expected to jump to $639 million by 2020 from the current level of $498 million a year. In 2000, diabetes cost Manitoba about $340 million. Nationwide, the cost is expected to hit $16 billion a year in 2020, up from $11.7 billion today.

While the main concern of those fighting diabetes is the disease's devastating human toll, experts say we can't turn a blind eye to the staggering impact the epidemic is having on government coffers and the wallets of patients battling high blood sugars.

"It's not just a health issue; it's an economic issue," Cloutier said in a later interview from Toronto. "Increased prevalence isn't just debilitating to people's lives, but it's a bigger societal issue in terms of the impact on the economy."

According to the diabetes association, of Manitoba's current $498-million tab for diabetes, 17 per cent (or $86 million) stems from so-called "direct costs," such as hospitalization and medications, whereas the remaining 83 per cent (or $412 million) is related to "indirect costs," defined as "the value of economic output lost due to illness, injury-related work disability or premature death."

"Not only are we dragging money out of the government coffers, but we're putting less money into the system because we're less productive," Cloutier said.

"When we think about a productive society, we have to be healthy to be productive. That has to have an impact on the economy."

He said diabetes is a hugely expensive disease because it can lead to so many costly complications. It's not only the leading cause of blindness, kidney failure and amputations; it's a driving force behind cardiovascular disease, including strokes and heart attacks.

Spending more now on diabetes prevention and treatment will save bundles down the road, he said, because 80 per cent of the costs of diabetes stem from treating its complications, not the disease itself.

"Think about the rehab costs of people going through stroke and heart attacks and dialysis," says Cloutier. "It's pretty hard to get dialysis in the workplace. If you can avoid those costs by treating diabetes, you're going to save a ton of money."

While praising Manitoba as one of the few provinces with a well-established diabetes strategy, the association has called on the province's NDP government to shift its focus toward supporting people already living with the disease.

For example, the number of Canadians living with kidney disease has tripled in 20 years and the dialysis treatments needed to keep them alive cost about $60,000 a year per patient. In Manitoba, people with diabetes are almost 10 times more likely than the general population to be diagnosed with chronic kidney disease.

Dr. Mauro Verrelli, a nephrologist at St. Boniface Hospital and medical director of the Manitoba Renal Program, said the "diabetes storm" is already stretching limited and expensive resources by fuelling a rapidly rising number of kidney patients.

"We have had significant challenges keeping up with the rapid growth of patients needing dialysis," Dr. Verrelli said in an interview. "We've had a large increment in numbers and they all require resources to provide those treatments.

"It's a whole spectrum of resources that are required... The demand on our resources is huge. It's hard to keep up. The sicker people are, the more specialized care they need."

Economist Robin Somerville, a director of the Centre for Spatial Economics, an Ontario-based firm that monitors and forecasts economic and demographic change throughout Canada, said there's no question the rising tide of Type 2 diabetes threatens our standard of living.

"The more people that are suffering from the disease, they're not working or buying as much and that impacts our standard of living," said Somerville, whose firm provided the economic forecast for the diabetes association. "The links are pretty direct.

The economist said avoiding the debilitating repercussions associated with chronic high blood sugars, which can take decades to show up, is the best way to cut the direct and indirect costs of the epidemic.

Diabetics also incur medical costs that are two to three times higher than those without diabetes, with direct costs for medication ranging from $1,000 to $15,000 a year.

In Manitoba, where diabetics account for about one-quarter of all days of hospitalization a year, the annual out-of-pocket expenses for someone with Type 2 diabetes are more than $2,500 a year, the highest level outside the Atlantic provinces. Studies show 57 per cent of Canadians can't afford their diabetes drugs and test strips.

Somerville noted the life expectancy for someone with Type 1 diabetes, in which the body no longer produces insulin, may be shortened as much as 15 years; while the life of someone with Type 2, in which the body does not effectively use the insulin it makes, may be shortened by five to 10 years.

Halting the spread of the disease not only saves lives, he said, it saves money.

"You're going from one in 20 people with the disease in Manitoba in 2000 to one in 10 people in 2020," he said, citing his firm's outlook for the province. "This is kind of the tip of the iceberg."

doug.speirs@freepress.mb.ca

Republished from the Winnipeg Free Press print edition July 2, 2011 J3

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