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

Abstract

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 ¼ 1,193) or together with a microvascular complication (N ¼ 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.

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

“…The geographical factors associated with an increased likelihood of high direct medical costs (Figure 2) may be partly explained by regional differences in access to tertiary care and diabetologists, as well as by the movement of patients between regions to access treatment. These findings are in line with and add to our previous demonstration of increased direct medical costs associated with macrovascular complications in Brazilian patients with diabetes [17]. Moreover, it should be noted that the odds of patients incurring high direct medical costs in the first and second year after the complication (versus baseline) were substantially greater for microvascular complications (ORs of 70-85; USD/patient of 1679 [first year] and 5172 [second year]) here, than for macrovascular complications with or without a microvascular complication (ORs of 3-6; USD/patient of 334 [first year] and 266 [second year]) in our previous study [17].…”

“…These findings are in line with and add to our previous demonstration of increased direct medical costs associated with macrovascular complications in Brazilian patients with diabetes [17]. Moreover, it should be noted that the odds of patients incurring high direct medical costs in the first and second year after the complication (versus baseline) were substantially greater for microvascular complications (ORs of 70-85; USD/patient of 1679 [first year] and 5172 [second year]) here, than for macrovascular complications with or without a microvascular complication (ORs of 3-6; USD/patient of 334 [first year] and 266 [second year]) in our previous study [17]. One potential explanation for this difference is the substantial rise in costs as nephropathy progresses [26]; the management of patients with end-A c c e p t e d M a n u s c r i p t stage kidney disease consumes considerable healthcare resources, requiring long-term dialysis or kidney transplantation [27].…”

“…Our results add to the growing evidence of the substantial economic burden on healthcare systems worldwide due to diabetes-related complications [8,9,12,17,31,32]. The high cost of managing diabetes represents a growing challenge for healthcare systems.…”

“…Detailed descriptions of the methodology and data sources utilized in this study have previously been published for an investigation of direct medical costs associated with macrovascular complications in Brazilian patients with diabetes [17]. Here we provide a summary of the methods used in the context of evaluating costs following a microvascular complication in Brazilian patients with diabetes.…”

“…The patient flow is presented in Figure 1. There were 774,244 patients with evidence of diabetes in DATASUS during the 7-year study period [17]. Of these patients, 692,722 patients did not have evidence of a diabetes-related complication during the study period and were excluded from the study.…”