Method: We use an adapted version of the most recently updated methodology of the American Diabetes Association (2013). This methodology uses a prevalence-based approach that combines current estimates of population demographics and diabetes prevalence rates with macro and microeconomic data from Singapore for the year 2010. We compute both disease-related direct medical costs and the costs of indirect productivity losses. Indirect productivity losses affect both individuals inside and outside the labor force. For those employed, productivity losses include diabetes-related days absent from work (absenteeism) and diabetes-related reductions in on-the-job productivity (presenteeism). Productivity losses also include the years of lost work from individuals who withdraw from the labor force due to diabetes-related disability, and the years of lost work from premature mortality. These losses can be sizable.
Result: We estimate productivity losses of approximately USD $5-600 million, including estimated losses due to absenteeism, presenteeism, lost productivity from non-participation in the labor force due to diabetes and lost productive capacity due to early mortality. Including estimates of direct medical costs raises the estimates of the total costs of diabetes in excess of USD 1 billion in 2010.
Conclusion: The economic burden of diabetes in Singapore is substantial. For working age adults in particular, the indirect productivity costs exceed disease-related direct medical costs. Public health planning and management should take not only the direct but indirect costs of diabetes into account when considering an appropriate response, as the prevalence of diabetes in Singapore is rising and projected to further increase over time in younger populations.