Introduction:
Globally, healthcare systems were adversely affected by the COVID-19 pandemic. COVID-19 affected healthcare access, utilization, and affordability, especially for patients suffering from chronic diseases including diabetes. We estimated direct healthcare costs among patients with type 2 diabetes in Kenya and Tanzania.

Methodology:
This cross-sectional study was conducted in Kenya and Tanzania in March-June among 1000 patients with type 2 diabetes (500 in each country). Data entailed the direct healthcare costs, societal costs, and other clinical and social variables for the period before COVID-19 and during the pandemic. The main outcome was the total direct healthcare costs, while the primary predictor was the time before and after COVID-19 adjusted for patient sociodemographic and clinical factors. A generalized linear regression model (GLM) was used in Kenya, while the Two-part model (logit + GLM) was used for Tanzania to identify predictors of costs.

Results:
A small non-statistically significant increase in total direct costs was observed in both countries. The mean direct healthcare costs for patients with type 2 diabetes in Kenya and Tanzania during COVID-19 increased to Kshs. 5,267.0(0-60,000) and TZshs. 17075.8(0-180,800), respectively. Type 2 diabetes testing costs increased significantly in both countries (Kenya: increase by Kshs. 567(233.56), p