title: The costs of type 2 diabetes mellitus outpatient care in the Brazilian public health system.
abstract: OBJECTIVE
  The prevalence of type 2 diabetes has shown a significant increase in parallel with health care costs. The objective of the Brazilian Study on Diabetes Costs (ESCUDI study) was to estimate direct and indirect costs of type 2 diabetes outpatient care in the Brazilian Public Health Care System.
  
  
  METHODS
  Data were collected from different levels of health care in eight Brazilian cities in 2007. A total of 1000 outpatients were interviewed and had their medical records data analyzed. Direct medical costs included expenses with medications, diagnostic tests, procedures, blood glucose test strips, and office visits. Nonmedical direct costs included expenses with diet products, transportation, and caregivers. Absenteeism, sick leave, and early retirement were classified as indirect costs.
  
  
  RESULTS
  Total annual cost for outpatient care was US$2108 per patient, out of which US$1335 per patient of direct costs (63.3%) and US$773 per patient of indirect costs (36.7%). Costs escalated as duration of diabetes and level of health care increased. Patients with both microvascular and macrovascular complications had higher costs (US$3199 per patient) compared to those with either microvascular (US$2062 per patient) or macrovascular (US$2517 per patient) complications only. The greatest portion of direct costs was attributed to medication (48.2%).
  
  
  CONCLUSIONS
  Diabetes treatment leads to elevated costs both to Brazilian Public Health Care System and society. Costs increased along with duration of disease, level of care and presence of chronic complications, which suggested a need to reallocate health resources focusing on primary prevention of diabetes and its complications.
authors.affiliation: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. lucianabahia@uol.com.br
authors.forename: Luciana R
authors.initials: LR
authors.lastname: Bahia
authors.forename: Denizar Vianna
authors.initials: DV
authors.lastname: Araujo
authors.forename: Beatriz D
authors.initials: BD
authors.lastname: Schaan
authors.forename: Sérgio A
authors.initials: SA
authors.lastname: Dib
authors.forename: Carlos Antônio
authors.initials: CA
authors.lastname: Negrato
authors.forename: Marluce P S
authors.initials: MP
authors.lastname: Leão
authors.forename: Alberto José S
authors.initials: AJ
authors.lastname: Ramos
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Forti
authors.forename: Marília B
authors.initials: MB
authors.lastname: Gomes
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Foss
authors.forename: Rosane A
authors.initials: RA
authors.lastname: Monteiro
authors.forename: Daniela
authors.initials: D
authors.lastname: Sartorelli
authors.forename: Laércio J
authors.initials: LJ
authors.lastname: Franco
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D001938:Brazil / Q000453:epidemiology; D017281:Cost of Illness; D048909:Diabetes Complications / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011634:Public Health / Q000191:economics*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019037:Urban Health Services / Q000191:economics