Background Valid and reliable estimates for the incremental costs attributable to diabetes at country-level are required to provide more precise estimates of the global cost of diabetes and to encourage and inform national responses to the diabetes epidemic. The most recent estimates for Ireland come from the CODEIRE study which uses data from the years 1999/2000 and employs a sum-all medical approach for a hospital-based sample of people with diabetes. Indirect costs are not estimated We estimate the total costs, direct and indirect, attributable to diabetes in older Irish adults.

Methods Adopting a societal perspective and using a prevalence-based approach, we estimate the direct costs (healthcare utilisation and medications) and indirect costs (participation in the labour force and premature mortality) attributable to diabetes in 2013. A human capital approach was used to estimate indirect costs. Where possible, incremental costing methodology was employed. Data sources include a nationally representative cohort study, a national pharmacy claims database and national vital statistics.

Results The estimated total cost of diabetes was €536,668,060 (95% CI: 360,172,044–751,720,140); €238,155,072 (95% CI: 192,023,954–278,959,992) in direct costs and €298,512,988 (95% CI: 168,148,090–472,760,148) in indirect costs. People with diabetes were 41% less likely to be employed than those without diabetes (p<0.001), with the loss in productivity estimated at €190,864,409 (95% CI: 104,107,859–294,972,268) or 36% of total costs. Prescription costs were the next largest contributor, calculated at €156,429,993. The total costs of premature mortality were estimated at €107,648,579 (95% CI: 64,040,231–177,787,880).

Conclusion We establish the societal costs attributable to diabetes in older adults in Ireland and therefore identify costs that can be directly targeted by prevention and treatment strategies. Primary, secondary and tertiary prevention of diabetes can result in significant cost savings, not only in terms of direct healthcare costs but also indirect costs.