title: Heterogeneity in the costs of type 1 diabetes in a developing country: what are the determining factors?
abstract: OBJECTIVE
  Regional differences in the clinical care of Type 1 diabetes (T1D) in Brazil have been recently described. This study aimed to estimate the costs of T1D from the public health care system's perspective across the regions of Brazil and to determine the components that influence these costs.
  
  
  METHODS
  This was a retrospective, cross-sectional and nationwide multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The study included 3,180 T1D subjects receiving healthcare from the National Brazilian Healthcare System (NBHCS) with a follow-up of at least one year. The direct medical costs were derived from the costs of medications, supplies, examinations, visits to the center, medical procedures and hospitalizations that occurred during the previous year. Clinical and demographic factors that determined the differences in the cost across four geographic regions (southeast, south, north/northeast and mid-west) were investigated.
  
  
  RESULTS
  The per capita mean annual direct medical costs of T1D in US$ were 1,466.36, 1,252.83, 1,148.09 and 1,396.30 in southeast, south, north/northeast and mid-west regions, respectively. The costs of T1D in the southeast region were higher compared to south (p < 0.001) and north/northeast regions (p = < 0.001), but not to the mid-west (p = 0.146) region. The frequency of self-monitoring of blood glucose (SMBG) was different across the regions as well as the daily number of SMBG, use of insulin pumps or basal or prandial insulin analogs. Age, ethnicity, duration of diabetes, level of care, socioeconomic status and the prevalence of chronic diabetic complications differed among the regions. In a regression model the determinants of the costs were the presence of microvascular diabetes-related complications (p < 0.001), higher economic status (p < 0.001), and being from the southeast region (p < 0.001).
  
  
  CONCLUSIONS
  The present data reinforce the regional differences in the costs of T1D and in the socioeconomic profile and health care provided to the patients with T1D in specialized public centers in Brazil. Both factors influenced directly the costs of T1D and should be considered for discussing future health policies.
authors.affiliation: Disciplina de Diabetes, State University Hospital of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil- Avenida 28 de setembro, 77, Terceiro andar, Vila Isabel 20551-030, Brazil. robertacobas@gmail.com.
authors.forename: Roberta Arnoldi
authors.initials: RA
authors.lastname: Cobas
authors.forename: Marcos
authors.initials: M
authors.lastname: Bosi Ferraz
authors.forename: Alessandra Saldanha de Mattos
authors.initials: AS
authors.lastname: Matheus
authors.forename: Lucianne Righeti Monteiro
authors.initials: LR
authors.lastname: Tannus
authors.forename: Aline Tiemi Kano
authors.initials: AT
authors.lastname: Silva
authors.forename: Luiz Antonio
authors.initials: LA
authors.lastname: de Araujo
authors.forename: Carlos Antonio
authors.initials: CA
authors.lastname: Negrato
authors.forename: Sérgio Atala
authors.initials: SA
authors.lastname: Dib
authors.forename: Marilia Brito
authors.initials: MB
authors.lastname: Gomes