Global and regional estimates and projections of diabetes-related health expenditure: Results from the International Diabetes Federation Diabetes Atlas, 9th edition Rhys Williams a , Suvi Karuranga b , Belma Malanda b , Pouya Saeedi b, * , Abdul Basit c , Ste ´phane Besanc ¸on d , Christian Bommer e , Alireza Esteghamati f , Katherine Ogurtsova g , Ping Zhang h , Stephen Colagiuri i a Diabetes Research Unit Cymru, Swansea University, Swansea, United Kingdom b International Diabetes Federation, Brussels, Belgium c Baqai Institute of Diabetology and Endocrinology (BIDE), Pakistan d ONG Sante ´ Diabe `te (SD), France e University of Goettingen, Germany f Tehran University of Medical Sciences, Iran g Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany h Centers for Disease Control, USA i The University of Sydney, School of Medicine, Australia ARTICLE INFO Article history: Received 10 February 2020 Accepted 10 February 2020 Available online 13 February 2020 Keywords: Diabetes Health expenditures Direct costs Economic impact Projections International Diabetes Federation ABSTRACT Aims: Diabetes and its complications have a significant economic impact on individuals and their families, health systems and national economies. Methods: The direct health expenditure of diabetes was calculated relying on the following inputs: diagnosed and undiagnosed diabetes prevalence estimates, United Nations popula- tion estimates, World Health Organization health expenditure per capita and ratios of health expenditure for people with diabetes compared to people without diabetes. Results: The estimated global direct health expenditure on diabetes in 2019 is USD 760 bil- lion and is expected to grow to a projected USD 825 billion by 2030 and USD 845 billion by 2045. There is a wide variation in annual health expenditures on diabetes. The United States of America has the highest estimated expenditure with USD 294.6 billion, followed by China and Brazil, with USD 109.0 billion and USD 52.3 billion, respectively. The age group with the largest annual diabetes-related health expenditure is 60–69 years with USD 177.7 billion, followed by 50–59 years, and 70–79 years with USD 173.0 billion and USD 171.5 bil- lion, respectively. Slightly higher diabetes-related health expenditure is seen in women than in men (USD 382.6 billion vs. USD 377.6 billion, respectively). The same difference is expected to be present in 2030 and 2045. https://doi.org/10.1016/j.diabres.2020.108072 0168-8227/Ó 2020 Elsevier B.V. All rights reserved. * Corresponding author. E-mail address: pouya.saeedi@idf.org (P. Saeedi). diabetes research and clinical practice 162 (2020) 108072 Contents available at ScienceDirect Diabetes Research and Clinical Practice journal homepage: www.elsevier.com/locate/diabres