Estimativa dos custos do Diabetes Mellitus e suas complicações no Brasil

Abstract

Chronic non-communicable diseases (NCD) are the main sources of disease burden in Brazil. In 2010 about 74% of the deaths in our country were attributed to NCD. Among them, we highlight the Diabetes Mellitus (DM), whose increasing prevalence in low- and middle-income countries has caused a significant economic and social impact. Understanding the share of the global burden of this disease is extremely important since the available resources are limited and their application must be done rationally. The main goal of this thesis was to estimate the costs of Diabetes Mellitus in adults in Brazil, considering the perspectives of the public health system and society. Applying the cost method based on prevalence, it was estimated the annual use of health resources and the costs attributable to diabetes and related conditions for the year 2014. The healthcare system perspective considered direct medical costs related to outpatient and hospitalization costs. The societal perspective considered non-medical (transportation and dietary products) and indirect costs (productivity loss, disability, and premature retirement). Outpatient costs included medicines, health professional visits, exams, home glucose monitoring, ophthalmologic procedures, and costs related to end-stage renal disease. The costs of hospitalization attributed to diabetes-related conditions were estimated using attributable risk methodology. Costs were estimated in Brazilian currency. Based on a self-reported national prevalence of 6.2%, and assuming that all patients with diabetes are on treatment, the total cost of diabetes in 2014 was 30 billion reais, including 12.04 billion reais in direct medical expenses (40.8%), 6.46 billion reais in non-medical costs (21.5%) and 11.49 billion reais in indirect costs (38.4%). Outpatient costs were estimated at about 11.58 billion reais. The cost of hospitalizations attributed to diabetes and related conditions was 462.98 million, corresponding to a total of 314,334 hospitalizations in one year. The costs of food and transportation were estimated at 5.65 billion and 808.05 million, respectively. The results demonstrated a substantial economic burden of diabetes in Brazil, however estimates are probably underestimated. Some of the reasons for this estimate to be conservative are the use of self-reported prevalence of diabetes, the non-inclusion of private health care costs and the costs of premature death. Health policies for diabetes prevention and control are urgently needed and the results can guide the prioritization of health care research and delivery, including prevention, diagnosis and treatment of diabetes.