Cost of macrovascular complications in people with diabetes from a public healthcare perspective: a retrospective database study in Brazil

• Published in: Journal of medical economics Vol. 23; no. 9; pp. 985 - 993
• Main Authors: Julian, Guilherme Silva, Campos, Daniel, Broe Honore, Julie, Sauer Tobaruella, Flávia, Hyun Yoon, Jung, Hallén, Nino
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.09.2020
• Subjects: cardiovascular disease; cost and cost analysis; Diabetes mellitus; healthcare expenditure; healthcare utilization; Latin America; cardiovascular disease; healthcare utilization; Diabetes mellitus; C25; I10; cost and cost analysis; healthcare expenditure; Latin America
• ISSN: 1369-6998; 1941-837X
• DOI: 10.1080/13696998.2020.1764966

Aims: To evaluate costs in patients with diabetes who experienced a macrovascular complication from a Brazilian public healthcare system perspective. Materials and methods: A retrospective, observational study that utilized the database of the Brazilian Unified Health System (DATASUS). Data for direct medical costs (hospitalization and outpatient) were extracted for patients with diabetes and a macrovascular complication (1 January 2012-31 December 2018) and converted to US Dollars (2019 USD). Mixed-effects logistic regression explored associations between demographic and clinical characteristics with the incurrence of high direct medical costs. Results: In total, 1,668 (0.2%) patients with diabetes met study inclusion criteria and experienced a macrovascular complication, either alone (N = 1,193) or together with a microvascular complication (N = 475). Median [95% CI] annual costs (USD/patient) were 130.5 [90.7; 264.2] at baseline, increasing to 334.0 [182.2; 923.5] in the first year after the complication. The odds of incurring high costs were significantly elevated in the first and second year (vs. baseline), and in patients who experienced a macrovascular and microvascular complication (vs. macrovascular alone) (all p < 0.001). Limitations: The DATASUS database does not cover primary care (it covers secondary and tertiary care), adding a selection bias to the sample. Additionally, our findings may not be representative of the entire Brazilian population given that approximately 75% of the population of Brazil depend exclusively on the SUS, while the remaining 25% have some access to private healthcare. Conclusions: This study has demonstrated higher medical costs from the perspective of the Brazilian public healthcare system in patients with diabetes after experiencing a macrovascular complication, either alone or in conjunction with a microvascular complication, in comparison with costs before the complication(s). In addition to providing up-to-date cost estimates, our findings highlight the need to implement strategies to reduce the cardiovascular risk in Brazilian patients with diabetes and drive cost savings.