Abstract
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.
Highlights
Among the various chronic complications that are associated with diabetes mellitus, diabetic foot disease (DFD) is highly frequent, being associated with significant morbidity, mortality, and costs.DFD includes an array of medical conditions, mainly resulting from diabetic peripheral neuropathyInt
The estimated prevalence of diabetic individuals with foot ulcer was estimated at 5.27%, and the prevalence of diabetic individuals with DFD requiring amputation was 1.36% when considering a positive response of surveyed individuals to question Q55 “Have you had any of the following diabetes complications?”, in which the respondent answered yes to “foot ulcer” (Q05506), and “amputation of lower extremities” (Q05507), respectively
We considered the available evidence obtained from national studies in the current literature for values of prevalence of diabetic foot disease among individuals with diabetes (9%) [14], and the proportion of diabetic patients with ulcer with infection (50%) [20]
Summary
Among the various chronic complications that are associated with diabetes mellitus, diabetic foot disease (DFD) is highly frequent, being associated with significant morbidity, mortality, and costs. The global prevalence of DFD varies between 3% in Oceania to 13% in North America, with a global average of 6.4% [1] It has been estimated in 2015 that each year foot ulcers develop in 9.1 million to 26.1 million people with diabetes worldwide [2]. Foot ulcers and amputation are more common in low and middle-income countries [5] In such a setting, evidence on the epidemiology of DFD is still lacking. The first comprehensive study of DFD in Brazil, the Brazilian Cooperative Study on Ulcer, Severe Peripheral Neuropathy and Amputation (BRAZUPA), conducted from 2012–2014, evaluated 1055 diabetic individuals in order to gather data on the current situation of foot at risk throughout the nation. Care System (SUS), when considering both outpatient and inpatient level, in 2014
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