Global economic burden of diabetic related hypoglycemia: a systematic review of cost of illness studies

Background Currently, diabetic hypoglycemic events are increasing, and this review aimed to synthesize global evidence on the economic burden of hypoglycemia. Method We conducted a systematic search in both databases (PubMed and Scopus) and a forward citation search. We included worldwide studies regardless of publication year. Two independent authors are involved in screening, selection, extraction, and quality appraisal. We used a consensus-based checklist for quality appraisal. We reported the costs in 2024 international dollars. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and registered the review with the International Prospective Register of Systematic Reviews (CRD420251069256). Result We reached out to 1235 articles and included 29 in the final report from high- and middle-income countries. Most studies estimated costs using prevalence-based and health system perspectives. The average direct and indirect costs per event per patient ranged from $1.90 to $24,932.73 and $3.46 to $3,339.34, respectively. The average annual direct cost per patient ranged from $1,938.41 to $25,092.76. This direct expense emerged from medications, consultation services, hospitalization, emergency care, and other services. Indirect costs primarily identified productivity losses due to sick leave, late arrivals, and early departures from work, with annual monetary estimates per patient ranging from $2,504.22 to $16,129.64. Patient direct costs were generally higher than the indirect costs. Annual hypoglycemia attributable costs ranged from $1,431.72 to $14,414.20 per patient per year. The annual national economic burden of hypoglycemia was substantial, ranging from $39.04 to $3.03 billion. Diabetes severity, type of diabetes, treatment regimen, and health facility level are sources of cost variation. Conclusion This systematic review concludes that diabetes-related hypoglycemia imposes a substantial economic burden, with both direct and indirect costs being significant. Preventive efforts focusing on hypoglycemia and its contributing factors are crucial to mitigate the financial impact on patients, healthcare providers, and the health system.