Pills or Pins? Financial Burdens of Combined Insulin Therapy Versus Oral Hypoglycemic Therapy Among Type 2 Diabetes Mellitus Patients During COVID-19 Pandemic

Objectives To determine the direct and indirect costs, including out-of-pocket-expenditure (OOPE) and catastrophic spending among Insulin vs. Oral hypoglycaemic Agent (OHA) therapy in patients with type 2 diabetes (T2DM) and explore its socio-economic impact in a rural community in Karnataka during COVID-19 pandemic. Material and Methods A rural community-based cross-sectional analytical study was conducted between 2019 and 2022, involving 66 T2DM patients receiving combined insulin (n=20), and only OHA (n=46) was recruited consecutively. Data on direct costs (medications, consultations, laboratory tests) and indirect costs (transportation, productivity loss), out-of-pocket-expenditure (OOPE), and catastrophic health expenditure (CHE) were estimated through data collected by face-to-face interviews during the COVID-19 pandemic, maintaining appropriate precautions. Analysis was conducted using SPSS v 29.0. Descriptive statistics were used to summarise the data of the participants. Inferential statistics, including Mann-Whitney U Test and Chi-square (Fisher’s exact test), were used to assess the difference between the groups. A p-value of < 0.05 was considered significant. Results The median direct medical costs (INR) were 1636.5(1282-14266.5) among those on combined insulin therapy and 741.5(397.5-1190) for those on only OHA, which differed significantly. The median direct non-medical costs and total indirect costs among those on combined insulin therapy and for those on only OHA didn’t differ significantly. The total OOP expenditures (INR) was 2421(2015.25-23654) differed significantly among those on combined insulin therapy compared to INR 1540(1046.75-2262.5) for those on only OHA. The catastrophic health expenditure (CHE) was 6(9.1%), which was significantly higher among those on combined insulin therapy than those on OHA. Conclusion The comparative financial burden of median direct medical costs (INR), CHE, and OOPE for individuals on combined insulin therapy was significantly higher than those on only OHA. Median non-medical and indirect costs did not significantly differ between individuals on combined insulin therapy and those on OHA.