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The public economic burden of sub-optimal type-2 diabetes control on tax payors in Sweden: Looking beyond health costs

Kotsopoulos N, Connolly M P, Willis M, Nilsson A, Ericsson Å, Baker-Knight J

The aim of this study was to estimate the fiscal burden for taxpayers in Sweden associated with type-2 diabetes (T2D) attributed to diabetes-related complications in patients failing to meet HbA1c targets.
We developed a public economic framework to assess how changes in diabetes related complications influenced projected tax contributions and government disability payments for people with T2D. The analysis applied accepted disease-modelling practices to estimate different rates of diabetes-related complications based on HbA1c of 6.9% (52 mmol/mol) and of 6.0% (42 mmol/mol). We adjusted the employment activity rates for those experiencing T2D-related events, applying age-specific earnings to estimate lifetime tax losses. Furthermore, the likelihood of receiving payments for health-related employment inactivity were estimated. Direct healthcare costs are excluded from this analysis.

The estimated per person earnings loss for immediate and delayed HbA1c control were SEK42,299 and SEK44,157, respectively over 10 years. The lost employment activity of people with T2D translates to lost tax revenues of SEK23,265 and SEK24,287 for immediate and delayed control, respectively. The estimated difference in disability payments was SEK538. Combining the tax revenue loss and excess disability defines the broader fiscal costs where we observe combined fiscal losses that favor immediate and sustained control by SEK1,560 over 10 years.

We demonstrate that conducting fiscal analysis of diabetes interventions offers an enriched perspective capturing a range of costs that fall on government in relation to lost tax revenue and disability payments. Tax-financed health systems may benefit from broadening consideration of costs and benefits when evaluating new interventions and treatment practices.

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Diabetes, Obesity and Metabolism,2022;24:1038-1046
DOI: 10.1111/dom.14667