Estimating the societal cost of type 2 diabetes in Malmö, Sweden: a register-based cost analysis.

Background: With the prevalence of Type 2 Diabetes (T2D) projected to increase, understanding its potential consequences on healthcare systems is crucial for adequately preparing society to address this growing challenge. In 2019, Malmö, Sweden's third-largest city, joined the Cities for Better Health global initiative to tackle the multifaceted challenges associated with T2D, including its significant economic burden on the healthcare system and the broader community. Understanding the economic burden of T2D on the healthcare system will facilitate optimisation of the initiatives undertaken by the programme. Therefore, this study aimed to estimate the costs associated with primary care, hospital care, and work absenteeism due to diabetes-related complications among people with T2D residing in Malmö. Methods: In order to estimate the cost for the City of Malmö, we expanded a model (Andersson et al., 2020) developed to estimate the cost of T2D on a national level, using retrospective data from 1997-2016. The costs were estimated by using NordDRG weights and national reference prices. Primary care costs for Region Skåne were added to the model. Data on healthcare utilisation, work absence, and socioeconomic factors were collected from Swedish national and regional registers. The method was expanded to include Malmö-specific adjustments for demographics, employment, and education, as well as regional primary care costs. Results: The prevalence of T2D in Malmö was 5.4%, and diabetes complications were: diabetic retinopathy (49.9%), diabetic kidney disease (19.1%), angina pectoris (13.7%), ischaemic heart disease (10.9%), and myocardial infarction (10.5%). Total excess costs for T2D in primary care were €12.7 million. The lowest primary care excess costs were in the age group 16-34 and the highest in the age group 65-74. Estimated overall hospital-based costs for T2D were €38.8 million, and costs related to macrovascular and microvascular complications were €18.1 million and €16.4 million, respectively. Estimated total cost due to absence from work related to T2D complications was €15.4 million. The complication costs were higher for men, except for neuropathy. Conclusions: These findings may support city-level healthcare planning and preventive interventions, as Malmö is facing substantial costs both in monetary terms and in reduced quality of life. Younger persons increasingly develop diabetes complications, which needs to be considered when allocating resources for primary prevention, treatment of complications, and municipality costs within a near future.