title: Predicted annual costs for inpatients with diabetes and foot ulcers in a developing country-a simulation of the current situation in Brazil.
abstract: OBJECTIVE
  The objective of this cost-of-illness analysis was to quantify the annual costs associated with hospital admission for people with diabetes and foot ulcers in Brazil.
  
  
  METHODS
  A hypothetical cohort was simulated using a decision tree model. Prevalence and incidence rates and clinical outcomes were estimated from published studies and applied to the general Brazilian population over 30 years. Costs were quoted in Brazilian real (BRL) and converted to US dollars ($US) at the 2008 currency exchange rate ($US1 = BRL 1.64). In the sensitivity analysis, we reduced and increased rates to assess the robustness of the cost estimates.
  
  
  RESULTS
  In this hypothetical cohort there are 6.48 million (95% confidence interval 4.47-7.12) Brazilians citizens with Type 2 diabetes. Each year, approximately 323,000 (89,500-484,500) of these people develop foot ulcers and almost 97,200 (17,900-169,600) require hospital admission as a result. Each year, almost 46,300 (8500-80,900) limb amputations and 12,400 (2300-21,700) deaths occur as a result of diabetic foot disease in Brazil. The annual cost associated with these hospital admissions is estimated to be almost $US264m ($US51m-461m). The estimated cost for patients with amputation is nearly $US128m ($US24.5m-222.3m).
  
  
  CONCLUSIONS
  Our model shows that the social and economic impact of diabetic foot disease in Brazil is high. Government decision makers should reflect on the current situation and provide organized foot care throughout the whole country.
authors.affiliation: Sergipe Federal University, Aracaju, Brazil. kfr@infonet.com.br
authors.forename: K F
authors.initials: KF
authors.lastname: Rezende
authors.forename: M B
authors.initials: MB
authors.lastname: Ferraz
authors.forename: D A
authors.initials: DA
authors.lastname: Malerbi
authors.forename: N H
authors.initials: NH
authors.lastname: Melo
authors.forename: M P
authors.initials: MP
authors.lastname: Nunes
authors.forename: H C
authors.initials: HC
authors.lastname: Pedrosa
authors.forename: A R
authors.initials: AR
authors.lastname: Chacra
mesh_terms: D000671:Amputation, Surgical / Q000191:economics*; D001938:Brazil / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D017719:Diabetic Foot / Q000191:economics* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence