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Int. J. Environ. Res. Public Health 2018, 15(1), 89; doi:10.3390/ijerph15010089

Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study

Collective Health Department, Federal University of Goiás, Goiânia, Goiás 74605-050, Brazil
Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil
Regional Hospital of Taguatinga, Brasilia 72120-970, Brazil
Social Medicine Department, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil
Author to whom correspondence should be addressed.
Received: 22 November 2017 / Revised: 31 December 2017 / Accepted: 1 January 2018 / Published: 8 January 2018
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The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance. View Full-Text
Keywords: diabetes mellitus; diabetic foot; cost and cost analysis; health care expenditure; Brazil; foot ulcer; amputation; neuropathy diabetes mellitus; diabetic foot; cost and cost analysis; health care expenditure; Brazil; foot ulcer; amputation; neuropathy

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MDPI and ACS Style

Toscano, C.M.; Sugita, T.H.; Rosa, M.Q.M.; Pedrosa, H.C.; Rosa, R.S.; Bahia, L.R. Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study. Int. J. Environ. Res. Public Health 2018, 15, 89.

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