Type 1 Diabetes Care Access and Cost: A Geospatial Study in Ghana, Peru, and Nepal

Abstract Type 1 diabetes poses a distinct challenge to health systems due to its low prevalence and need for continuous access to insulin and care. This study aims to model the geographic accessibility to centralised versus decentralised Type 1 diabetes (T1D) services, and the implications for the population. Two care models for T1D were compared: centralised, where care is provided mostly at large hospitals, and decentralised care, involving an annual visit to a large hospital with routine care provided locally at smaller facilities. Geospatial accessibility and expense analyses were conducted for Ghana, Nepal, and Peru, to assess access to care and likely associated financial impact. Specialised, large hospitals provided > 82%, 35%, and > 72% population coverage within two hours’ travel time for Ghana, Peru, and Nepal, respectively. Smaller hospitals covered about 92%, 50%, and 44% of the population within one hour. Annual per-person costs were highest in Peru (USD 1,280) and lowest in Nepal (USD 499), largely due to treatment costs. Travel-related costs per person were lowest in Ghana and highest in Peru. Travel-related costs per person were lowest in Ghana (about USD 14) and highest in Peru (approximately USD 354). Geographical factors critically influence the economic burden of T1D. The distribution of facilities, characteristics of the terrain, and distances involved, strongly influenced the accessibility and costs for T1D care. This emphasizes the necessity for country-specific geospatial planning to achieve equitable care and the World Health Organization Global Diabetes coverage targets.