Aaliyah, 28, stood at the pharmacy counter, her hands trembling as she held the pharmacy receipt. It read, “Actrapid (10ml vial) – GH¢ 130”. She needed two vials but is a student with no steady source of income thus, did not have that amount. She thought of rationing and in a moment of sheer desperation pulled out her phone to do the one thing that came to mind: googled “how to survive without insulin as a diabetic.”

This is not a story from a fictional novel but a pending crisis over 4.16 million Ghanaians have to face daily: pay the medical bill for the drug that keeps you alive or pay for everything else and risk complications or death. The thought which occurred to Aaliyah, her desperate move, and her dilemma all are due to the cost of her illness, diabetes. The cost of diabetes could be understood from the quintessence of financial toxicity. Let’s break it down.

Diabetes could spur a range of emotions from the reality of living with a chronic disease to the endless purchase and intake of medications. Abstract as it may seem, the rise of these emotions coupled with the cage of continuous self-check in buying food items, eating at appropriate times, avoiding once preferable meals could throw an individual into catastrophic thinking. These reflect the mental strain Aaliyah was facing. Although debilitating particularly at the point of rationing, the measurable costs of diabetes are those of great necessity to her considering she is a student.

What then are the measurable costs of diabetes? They include her absenteeism from class when her insulin needs become imminent or when her insulin requirements exceed that prescribed. This could lead to missed leisure hours, low grade points and to the point of decreased confidence in academic pursuits. If she were to be an employee, the same points could be made with additions such as higher insurance premiums and productivity loss which could also result in getting laid in the presence of records showing high rates of sick absence.

In addition, measurable costs also include the direct costs of the disease – the easily noticeable cost of any disease. Diabetes of whichever type could lead one to incur lots of medical bills. These bills could include diabetic medication costs, insulin costs, costs of specialists’ visits and costs of glucose test strips, continuous glucose monitors, insulin pumps or syringes. These bills could emerge consequentially or follow no specific order with a high likelihood of paying for more than two of such costs. This discussion could take a much drastic turn if the individual living with diabetes is hospitalized or develops complications such as foot ulcers or develops several co-morbidities.

The incidence of diabetes in Ghana is reported to be between 2.6% – 9% with over 200,000 cases of diabetes reported annually to health facilities. These astonishing statistics, together with the measurable costs borne partly by the government, insurance companies and the individuals living with diabetes, raises the total cost to a mean of GH₵ 639.6 million per 200,000 cases annually (95% CI 547.5 million to 737 million). These staggering values, mental strain, physical exhaustion and productivity loss in the effort to manage diabetes could even become a side effect, worsening the disease and continuing a vicious cycle.

Author:

Mariam Pinaman Agyemang