Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-26T05:22:21.329Z Has data issue: false hasContentIssue false
  • English
  • Français

DIRECT COSTS OF TYPE 2 DIABETES: A BRAZILIAN COST-OF-ILLNESS STUDY

Published online by Cambridge University Press:  10 April 2018

Ricardo Saad Henriques ,
Laiza Maria Steimbach ,
Deise Regina Baptista ,
Luana Lenzi ,
Fernanda S. Tonin ,
Roberto Pontarolo  and
Astrid Wiens
Ricardo Saad Henriques
Affiliation:
Pharmaceutical Sciences at Federal University of Paraná
Laiza Maria Steimbach
Affiliation:
Pharmaceutical Sciences at Federal University of Paraná
Deise Regina Baptista
Affiliation:
Pharmaceutical Sciences at Federal University of Paraná Department of Nutrition, Universidade Federal do Paraná
Luana Lenzi
Affiliation:
Pharmaceutical Sciences at Federal University of Paraná Department of Clinical Analysis, Universidade Federal do Paraná
Fernanda S. Tonin
Affiliation:
Pharmaceutical Sciences at Federal University of Paraná
Roberto Pontarolo
Affiliation:
Biochemistry at Federal University of Paraná Department of Pharmacy, Universidade Federal do Paraná
Astrid Wiens
Affiliation:
Department of Pharmacy, Universidade Federal do Paraná. astrid@ufpr.br
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The aim of this study was to evaluate the direct costs of type 2 diabetes mellitus patients treated in a Brazilian public hospital.

Methods: This was an exploratory retrospective cost-of-illness study with quantitative approach, using medical records of patients treated in a public hospital (2012–14), with at least one consultation over a period of 12 months. Data on patient's profile, exams, number of consultations, medications, hospitalizations, and comorbidities were collected. The cost per patient per year (pppy) was calculated as well as the costs related to glycated hemoglobin (HbA1c) values, using thresholds of 7 and 8 percent.

Results: Data of 726 patients were collected with mean age of 62 ± 11 years (68.3 percent female). A total of 67.1 percent presented HbA1c > 7 percent and 44.9 percent > 8 percent. The median cost of diabetes was United States dollar (USD) 197 pppy. The median costs of medication were USD 152.49 pppy, while costs of exams and consultations were USD 40.57 pppy and 8.70 pppy, respectively. Thirty-eight patients (4 percent) were hospitalized and presented a median cost of 3,656 per patient per hospitalization with a cost equivalent to 53.1 percent of total expenses. Total costs of patients with HbA1c ≤ 7 percent were lower for this group and also costs of medications and consultations, whereas for patients with HbA1c ≤ 8 percent, only total costs and costs of medications were lower when compared with HbA1c > 8 percent patients.

Conclusions: Medications and hospitalizations were the major contributor of diabetes expenses. Preventing T2DM, or reducing its complications through adequate control, may help avoid the substantial costs related to this disease.

Keywords

Type 2 diabetes mellitusCost-of-illnessPublic hospital
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 34 , Issue 2 , 2018 , pp. 180 - 188
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. IDF. International Diabetes Federation Diabetes Atlas. 2015. Brussels, Belgium: International Diabetes Federation.Google Scholar
2. Bertoldi, AD, Kanavos, P, França, GV, et al. Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: A comprehensive literature review. Global Health. 2013;9:62.CrossRefGoogle ScholarPubMed
3. ADA. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care. 2002;25:202-212.Google Scholar
4. No authors. Standards of medical care in diabetes. Diabetes Care. 2015;38 (Suppl. 1): S86-S87.Google Scholar
5. de Almeida-Pititto, B, Dias, ML, de Moraes, AC, et al. Type 2 diabetes in Brazil: Epidemiology and management. Diabetes Metab Syndr Obes. 2015;8:17-28.Google Scholar
6. Borges, NB, Ferraz, MB, Chacra, AR. The cost of type 2 diabetes in Brazil: Evaluation of a diabetes care center in the city of Sao Paulo, Brazil. Diabetol Metab Syndr. 2014;6:122.Google Scholar
7. Dominguez, BC. Diabetes - Controle ainda é baixo no Brasil. Radis. 2007;59:11.Google Scholar
8. Baptista, DR, Thieme, RD, Reis, WC, Pontarolo, R, Correr, CJ. Proportion of Brazilian diabetes patients that achieve treatment goals: Implications for better quality of care. Diabetol Metab Syndr. 2015;7:113.Google Scholar
9. Viana, LV, Leitão, CB, Kramer, CK, et al. Poor glycaemic control in Brazilian patients with type 2 diabetes attending the public healthcare system: A cross-sectional study. BMJ Open. 2013;3:e003336.Google Scholar
10. Caporale, JE, Pichón-Riviere, A, Beratarrechea, AG, VonSchulz-Hausmann, C, Augustovski, F. A comparison of 1-year treatment costs in patients with type 2 diabetes following initiation of insulin glargine or insulin detemir in Argentina. Value Health Reg Issues. 2014;5:14-19.CrossRefGoogle ScholarPubMed
11. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033-1046.Google Scholar
12. Domeikiene, A, Vaivadaitė, J, Ivanauskienė, R, Padaiga, Ž. Direct cost of patients with type 2 diabetes mellitus healthcare and its complications in Lithuania. Medicina (Kaunas). 2014;50:54-60.Google Scholar
13. Bahia, LR, Araujo, DV, Schaan, BD, et al. The costs of type 2 diabetes mellitus outpatient care in the Brazilian public health system. Value Health. 2011;14 (Suppl 1):S137-S140.Google Scholar
14. Seuring, T, Archangelidi, O, Suhrcke, M. The economic costs of type 2 diabetes: A global systematic review. Pharmacoeconomics. 2015;33:811-831.Google Scholar
15. Ettaro, L, Songer, TJ, Zhang, P, Engelgau, MM. Cost-of-illness studies in diabetes mellitus. Pharmacoeconomics. 2004;22:149-164.Google Scholar
16. Pradelli, L, Wertheimer, A. Pharmacoeconomics: Principles and practice. 1st ed. Turin, Italy: SEEd Medical Publishers; 2013.Google Scholar
17. Byford, S, Torgerson, DJ, Raftery, J. Economic note: Cost of illness studies. BMJ. 2000;320:1335.Google Scholar
18. Milech, A, Angelucci, AP, Golbert, A, et al. Diretrizes da Sociedade Brasileira de Diabetes (SBD). Rio de Janeiro: AC Farmacêutica; 2016.Google Scholar
19. Brazil. Diretrizes SBD 2015–2016 - Sociedade Brasileira de Diabetes. 2016.Google Scholar
20. Dixit, AK, Dey, R, Suresh, A, et al. The prevalence of dyslipidemia in patients with diabetes mellitus of ayurveda Hospital. J Diabetes Metab Disord. 2014;13:58.CrossRefGoogle ScholarPubMed
21. Stone, NJ, Robinson, JG, Lichtenstein, AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129 (Suppl 2):S1-S45.Google Scholar
22. Posicionamento Oficial n. 01/2015 - Recomendações sobre o uso de estatinas em pessoas com diabetes. 2015, Sociedade Brasileira de Diabetes.Google Scholar
23. American Diabetes Association. Standards of medical care in diabetes-2016 abridged for primary care providers. Clin Diabetes. 2016;34:3-21.Google Scholar
24. No authors. [The Helsinki Declaration of the World Medical Association (WMA). Ethical principles of medical research involving human subjects]. Pol Merkur Lekarski. 2014;36:298-301.Google Scholar
25. Meah, F, Juneja, R. Insulin tactics in type 2 diabetes. Med Clin North Am. 2015;99:157-186.Google Scholar
26. Holman, R. Metformin as first choice in oral diabetes treatment: The UKPDS experience. Journ Annu Diabetol Hotel Dieu. 2007:13-20.Google Scholar
27. Sanchez-Rangel, E, Inzucchi, SE. Metformin: Clinical use in type 2 diabetes. Diabetologia. 2017;60:1586-1593.Google Scholar
28. Liebl, A, Khunti, K, Orozco-Beltran, D, Yale, JF. Health economic evaluation of type 2 diabetes mellitus: A clinical practice focused review. Clin Med Insights Endocrinol Diabetes. 2015;8:13-9.Google Scholar
29. Kalkan, A, Bodegard, J, Sundström, J, et al. Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice. Prim Care Diabetes. 2017;11:184-192.Google Scholar
30. Sharma, M, Nazareth, I, Petersen, I. Trends in incidence, prevalence and prescribing in type 2 diabetes mellitus between 2000 and 2013 in primary care: A retrospective cohort study. BMJ Open, 2016;6:e010210.Google Scholar
31. Weng, W, Liang, Y, Kimball, ES, et al. Drug usage patterns and treatment costs in newly-diagnosed type 2 diabetes mellitus cases, 2007 vs 2012: Findings from a large US healthcare claims database analysis. J Med Econ. 2016;19:655-662.Google Scholar
32. Filion, KB, Joseph, L, Boivin, JF, Suissa, S, Brophy, JM. Trends in the prescription of anti-diabetic medications in the United Kingdom: A population-based analysis. Pharmacoepidemiol Drug Saf. 2009;18:973-976.Google Scholar
33. Liatis, S, Dafoulas, GE, Kani, C, et al. The prevalence and treatment patterns of diabetes in the Greek population based on real-world data from the nation-wide prescription database. Diabetes Res Clin Pract. 2016;118:162-167.Google Scholar
34. Luijks, H, Schermer, T, Bor, H, et al. Prevalence and incidence density rates of chronic comorbidity in type 2 diabetes patients: An exploratory cohort study. BMC Med. 2012;10:128.Google Scholar
35. Struijs, JN, Baan, CA, Schellevis, FG, Westert, GP, van den Bos, GA. Comorbidity in patients with diabetes mellitus: Impact on medical health care utilization. BMC Health Serv Res. 2006;6:84.Google Scholar
36. Araujo, DV, Ribeiro de Souza, CP, Bahia, LR, et al. [Analysis of cost-effectiveness of simvastatin versus atorvastatin in the secondary prevention of cardiovascular events within the Brazilian public healthcare system]. Value Health. 2011;14 (5 Suppl 1):S29-Ss32.Google Scholar
37. Schachter, M. Statins - all the same?. HEART UK – The Cholesterol Charity, 2014. https://heartuk.org.uk/files/uploads/documents/huk_fs_mfsJ_statinsallthesame.pdf (Accessed March 14, 2018).Google Scholar
38. Sathyapalan, T, Atkin, SL, Kilpatrick, ES. Disparate effects of atorvastatin compared with simvastatin on C-reactive protein concentrations in patients with type 2 diabetes. Diabetes Care. 2010;33:1948-1950.Google Scholar
39. Marsola, APZC. Análise econômica e da Influência sobre a morbimortalidade cardiovascular de estatinas e fibratos utilizados no tratamento de portadores de dislipidemia em Ribeirão Preto-SP, in Faculdade de Ciências Farmacêuticas de Ribeirão Preto. São Paulo: Universidade de São Paulo; 2010.Google Scholar
40. Mata-Cases, M, Casajuana, M, Franch-Nadal, J, et al. Direct medical costs attributable to type 2 diabetes mellitus: A population-based study in Catalonia, Spain. Eur J Health Econ. 2016;17:1001-1010.Google Scholar
41. Migdalis, I, Rombopoulos, G, Hatzikou, M, et al. The cost of managing type 2 diabetes mellitus in Greece: A retrospective analysis of 10-year patient level data “The HERCULES Study”. Int J Endocrinol. 2015;2015:520759.Google Scholar
42. Jonsson, B, CODE-2 Advisory Board. Revealing the cost of Type II diabetes in Europe. Diabetologia. 2002;45:S5-S12.Google Scholar
43. Cao, P, Wang, K, Zhang, H, Zhao, R, Li, C. Factors influencing the hospitalization costs of patients with type 2 diabetes. Asia Pac J Public Health. 2015;27 (Suppl):55S-60S.Google Scholar
44. Saundankar, V, Ellis, J, Allen, E, et al. Type 2 diabetes mellitus patients' healthcare costs related to inpatient hospitalizations: A retrospective administrative claims database study. Adv Ther. 2015;32: 662-679.CrossRefGoogle ScholarPubMed
45. Hoffmann, F, Claessen, H, Morbach, S, et al. Impact of diabetes on costs before and after major lower extremity amputations in Germany. J Diabetes Complications. 2013;27:467-472.Google Scholar
46. Rasekaba, TM, Lim, WK, Hutchinson, AF. Effect of a chronic disease management service for patients with diabetes on hospitalisation and acute care costs. Aust Health Rev. 2012;36:205-212.Google Scholar
47. Athanasakis, K, Ollandezos, M, Angeli, A, et al. Estimating the direct cost of Type 2 diabetes in Greece: The effects of blood glucose regulation on patient cost. Diabet Med. 2010;27:679-684.Google Scholar
48. Bash, LD, Selvin, E, Steffes, M, Coresh, J, Astor, BC. Poor glycemic control in diabetes and the risk of incident chronic kidney disease even in the absence of albuminuria and retinopathy: Atherosclerosis Risk in Communities (ARIC) Study. Arch Intern Med. 2008;168:2440-2447.Google Scholar
49. Hemmingsen, B, Lund, SS, Gluud, C, et al. WITHDRAWN: Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2015:CD008143.CrossRefGoogle Scholar
Supplementary material: File

Henriques et al. supplementary material

Table S1

Download Henriques et al. supplementary material(File)
File 14.1 KB
Supplementary material: File

Henriques et al. supplementary material

Table S2

Download Henriques et al. supplementary material(File)
File 14.1 KB
Supplementary material: File

Henriques et al. supplementary material

Table S3

Download Henriques et al. supplementary material(File)
File 14.2 KB