Economic cost of diabetes in the Eastern Mediterranean region countries: A meta-analysis Alireza Ansari-Moghaddam a , Fatemeh Setoodehzadeh a, * , Mohammad Khammarnia a , Hossein Ali Adineh b a Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran b Department of Epidemiology and Biostatistics, Iranshahr University of Medical Sciences, Iranshahr, Iran article info Article history: Received 11 December 2019 Received in revised form 18 June 2020 Accepted 19 June 2020 Keywords: Cost of illness Diabetes meta-Analysis abstract Background and aims: Non communicable diseases including diabetes imposes substantial financial burden on households, societies and nations in both developed and developing countries. However, there is no information on the extent of diabetes expenditure in the Eastern Mediterranean Region (EMRO). Therefore, this study aimed to identify the treatment costs of diabetes in this area. To our knowledge, this is the first systematic review on treatment expenditures of diabetes in EMRO countries. Methods: A comprehensive literature search was conducted in PUBMED, MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCES databases to find out published manuscripts on treatment cost of diabetes. Infor- mation was extracted using data extraction sheets and then the data were imported into STATA software version.11. Mean annual treatment cost of diabetes per patient, annual treatment costs of diabetes per patient by Diabetes Mellitus (DM) complications and finally, cost of chronic diabetes complications per patient were pooled and reported. Results: After reviewing title, abstract and the full text of identified articles; a total of seven studies were reported appropriate data for this meta-analysis. The pooled annual treatment cost per diabetes patient for EMRO countries was 1150 US$ (95% CI: 595e2221) which was 3358 US$ (95% CI: 2200e5124) in EMRO countries except of Iran compared to 255 US$ (92e708) in Iran. The treatment cost of diabetes was higher in males, insulin-used and in the patient with family history of diabetes. The cost of diabetes was significantly increased with the duration of diabetes (P ¼ 0.001) as well. According to the results, the largest share of costs is related to medication costs. Finally, the pooled average annual treatment cost per patient by diabetes mellitus complications was varied from 2828 US$ in the patients that have cere- brovascular disease complication to 7261 US$ in the patients with Stroke complication. Conclusions: This study demonstrated that the annual treatment cost of diabetes is varied within EMRO countries. Qatar and Iran have spent the highest and lowest cost for diabetes, respectively. This may be due to the large socioeconomic differences between countries and special conditions of them such as currency value in the region. © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved. 1. Introduction Diabetes is a common chronic disease which is rapidly and steadily increasing in both developed and developing countries(1, 2). Moreover, it moved from the eighth to the sixth global leading causes of disability from 2005 to 2015(1). The escalation of diabetes prevalence resulted in the worldwide increase of body-mass index as well [3]. Accordingly, health systems will be exposed serious challenges due to overwhelming costs of disease treatment and its complications including cardiovascular, cancer and other chronic diseases in the near futures[4]. This would be more important in regions with high prevalence of diabetes such as Central America, Middle East, Oceania and North Africa [5]. Additionally, society could face a substantial burden of diabetes in the form of high medical costs, loss of productivity, premature mortality, and intangible costs in the form of reduced quality of life. Then, it is expected to witness an increasing economic burden of diabetes on national health care systems with approximately $490 billion (USD) * Corresponding author. E-mail address: fsetudezade@gmail.com (F. Setoodehzadeh). Contents lists available at ScienceDirect Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepage: www.elsevier.com/locate/dsx https://doi.org/10.1016/j.dsx.2020.06.044 1871-4021/© 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 14 (2020) 1101e1108