Heterogeneity in the costs of type 1 diabetes in a developing country: what are the determining factors?

Diabetology & Metabolic Syndrome

Marilia Brito Gomes²  Sérgio Atala Dib³  Carlos Antonio Negrato¹  Luiz Antonio de Araujo⁴  Aline Tiemi Kano Silva²  Lucianne Righeti Monteiro Tannus²  Alessandra Saldanha de Mattos Matheus²  Marcos Bosi Ferraz³  Roberta Arnoldi Cobas² 

[1] Bauru’s Diabetics Association, Brazil- Avenida Nações Unidas, 28-40, Bauru 17011-105, Brazil;Disciplina de Diabetes, State University Hospital of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil- Avenida 28 de setembro, 77, Terceiro andar, Vila Isabel 20551-030, Brazil;Federal University of São Paulo (UNIFESP), São Paulo, Brazil- Rua Botucatu, 685, Vila Mariana, Brazil;Joinville Endocrinology and Diabetes Institute, Santa Catarina, Brazil- Rua Alexandre Dohler 129, Joinville 89201-260, Brazil

关键词: Chronic complications;    Direct costs of type 1 diabetes;    Type 1 diabetes;   

Others  :  812278
DOI  :  10.1186/1758-5996-5-83

 received in 2013-08-09, accepted in 2013-12-20,  发布年份 2013

【 摘 要 】

Background and aims

Regional differences in the clinical care of Type 1 diabetes (T1D) in Brazil have been recently described. This study aimed to estimate the costs of T1D from the public health care system’s perspective across the regions of Brazil and to determine the components that influence these costs.

Methods

This was a retrospective, cross-sectional and nationwide multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The study included 3,180 T1D subjects receiving healthcare from the National Brazilian Healthcare System (NBHCS) with a follow-up of at least one year. The direct medical costs were derived from the costs of medications, supplies, examinations, visits to the center, medical procedures and hospitalizations that occurred during the previous year. Clinical and demographic factors that determined the differences in the cost across four geographic regions (southeast, south, north/northeast and mid-west) were investigated.

Results

The per capita mean annual direct medical costs of T1D in US$ were 1,466.36, 1,252.83, 1,148.09 and 1,396.30 in southeast, south, north/northeast and mid-west regions, respectively. The costs of T1D in the southeast region were higher compared to south (p < 0.001) and north/northeast regions (p = < 0.001), but not to the mid-west (p = 0.146) region. The frequency of self-monitoring of blood glucose (SMBG) was different across the regions as well as the daily number of SMBG, use of insulin pumps or basal or prandial insulin analogs. Age, ethnicity, duration of diabetes, level of care, socioeconomic status and the prevalence of chronic diabetic complications differed among the regions. In a regression model the determinants of the costs were the presence of microvascular diabetes-related complications (p < 0.001), higher economic status (p < 0.001), and being from the southeast region (p < 0.001).

Conclusions

The present data reinforce the regional differences in the costs of T1D and in the socioeconomic profile and health care provided to the patients with T1D in specialized public centers in Brazil. Both factors influenced directly the costs of T1D and should be considered for discussing future health policies.

【 授权许可】

   
2013 Cobas et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Sr F, Franco LJ, Vivolo MA, Negrato CA, Simoes AC, Ventureli CR: Population-based incidence of IDDM in the State of São Paulo, Brazil. Diabetes Care 1993, 16:701-04.
• [2]Negrato CA, Dias JP, Teixeira MF, Dias A, Salgado MH, Lauris JR, Montenegro RM Jr, Gomes MB, Jovanovic L: Temporal trends in incidence of type 1 diabetes between 1986 and 2006 in brazil. J Endocrinol Invest 2010, 33:373-77.
• [3]Gomes MB, Coral M, Cobas RA, Dib SA, Canani LH, Nery M, De Freitas MC, Faria M, Felício JS, Da Silva SC, Pedrosa H, Costae Forti A, Rea RR, Pires AC, Montenegro Junior R, Oliveira JE, Rassi N, Negrato CA: Prevalence of adults with type 1 diabetes who meet the goals of care in daily clinical practice: a nationwide multicenter study in brazil. Diabetes Res Clin Pract 2012, 97:63-70.
• [4]Instituto Brasileiro de Geografia e Estatística: Censo demográfico 2010. : ; 2010. Available from: http://www.ibge.gov.br/home/estatistica/populacao/censo2010/caracteristicas_da_populacao/tabelas_pdf/tab1.pdf webcite. Accessed 15 March 2012
• [5]Instituto Brasileiro de Geografia e Estatística (2010): Uma análise das condições de vida da população brasileira 2010. [http://www.ibge.gov.br/home/estatistica/populacao/condicaodevida/indicadoresminimos/sinteseindicsociais2010/default.shtm webcite]
• [6]Cobas RA, Ferraz MB, Matheus ASM, Tannus LRM, Negrato CA, Araujo LA, Dib SA, Gomes MB: The cost of type 1 diabetes: a nationwide multicentre study in Brazil. Bull World Health Organ 2013, 91:434-40.
• [7]Gomes MB, Cobas RA, Matheus ASM, Tannus LRM, Negrato CA, Rodacki M, Braga N, Cordeiro MM, Luescher JL, Berardo RS, Nery M, Arruda-Marques MC, Calliari LE, Noronha RM, Manna TD, Zajdenverg L, Salvodelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Guedes M, Dib SA, Dualib P, Silva SC, Sepulvida J, Almeida HG, Sampaio E, Rea R, et al.: Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian type 1 diabetes study group. Diabetol Metab Syndr 2012, 4:44. doi:10.1186/1758-5996-4-44 BioMed Central Full Text
• [8]ABEP: Brazilian Economic classification criteria. 2012. [http://www.abep.org/novo/Content.aspx?SectionID=84 webcite]
• [9]Portal da saúde (SUS): Banco de preços em saúde. 2011. [http://portal2.saude.gov.br/BPS/visao/consultapublica/publico_interno_item.cfm webcite]
• [10]Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR: Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Position statement of the American diabetes association (ADA) and the European association for the study of diabetes (EASD). Diabetes Care 2012, 35:1364-1379.
• [11]DCCT: The diabetes control and complications trial. N Engl J Med 1993, 329:977-86.