Economic burden of inpatient care among patients with type 2 diabetes mellitus: A tertiary hospital experience from Pune, India

ABSTRACT Background: Type 2 diabetes mellitus (T2DM) imposes a substantial economic burden on healthcare systems and patients; however, detailed evidence on inpatient costs in India remains limited. This study aimed to estimate direct hospitalization costs and identify factors associated with inpatient expenditure among patients with T2DM. Materials and Methods: An ambispective observational study was conducted at a tertiary care teaching hospital in Pune, India, between September 2023 and May 2025. A total of 381 hospitalized adults with T2DM were included. Direct medical costs were estimated using a bottom-up (micro-costing) approach based on itemized hospital billing records. Costs related to hospitalization, investigations, consultations, and medications were analyzed across patient characteristics, complications, and comorbidities. Results: The mean age of participants was 55.98 years, and 56.69% were male. The mean length of stay (LOS) was 7.79 days, while the mean total hospitalization cost was ₹18,868.15. The median total cost was ₹14,406.64 (interquartile range: ₹8,737.77–₹23,483.47). Investigations constituted the largest component of expenditure, followed by medications and hospitalization charges. LOS was positively associated with total cost ( ρ = 0.526, P < 0.001), and significant cost differences were observed across treatment modalities ( P < 0.001). Although patients with complications incurred higher average costs, the difference was not statistically significant ( P = 0.443). Cardiovascular complications were the most prevalent (33.33%), and 61.15% of patients had no comorbidities. Conclusion: Inpatient management of T2DM is associated with substantial healthcare expenditure, driven primarily by investigations, LOS, and treatment modality. These findings provide valuable evidence for healthcare planning and resource allocation. Further multicenter studies incorporating broader economic perspectives are warranted to better characterize the economic burden of diabetes in India.