University of Brasília, Brasília, Federal District, Brazil.
National Institute os Science and Technology for health Technology Assessment (IATS)-CNPq, Porto Alegre, Rio Grande do Sul, Brazil.
PLoS One. 2018 Oct 1;13(10):e0203992. doi: 10.1371/journal.pone.0203992. eCollection 2018.
Diabetes is the most common cause of chronic kidney disease, with a high economic impact on health systems.
To estimate the cost of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) attributable to diabetes, stratified by sex, race/skin color, and age, from the perspective of the Brazilian public health system between 2010 and 2016.
Population attributable risk (PAR) was calculated from the Brazilian prevalence of diabetes and the relative risk (or odds ratio) of persons with diabetes developing CKD and ESKD as compared to non-diabetic subjects. The variables of interest were sex, race/skin color, and age. A top-down approach was used to measure the direct costs of the disease reimbursed by the Brazilian Ministry of Health, using data from outpatient and inpatient records.
The cost of CKD and ESKD attributable to diabetes in the period 2010-2016 was US$1.2 billion (US$180 million per year) and trending upward. Female sex, age 65-75, and black race/skin color contributed substantially to the costs of CKD and ESKD (US$475 million, US$63 million, and US$25 million respectively). The clinical procedures accounting for the greatest share of disease-attributable costs are hemodialysis and peritoneal dialysis.
Diabetes accounted for 22% of the costs of CKD and ESKD. Female sex, age 65-75 years, and black race/skin color were the variables which contributed most to disease-related expenditure. The economic burden of CKD may increase gradually in the coming years, with serious implications for the financial sustainability of the Brazilian public health system.
糖尿病是慢性肾脏病的最常见病因，对卫生系统的经济影响巨大。
本研究旨在从巴西公共卫生系统的角度出发，估计 2010 年至 2016 年期间，归因于糖尿病的慢性肾脏病（CKD）和终末期肾病（ESKD）的成本，按性别、种族/肤色和年龄进行分层。
通过巴西糖尿病流行率和糖尿病患者发生 CKD 和 ESKD 的相对风险（或比值比），计算人群归因风险（PAR）。本研究的感兴趣变量为性别、种族/肤色和年龄。采用自上而下的方法，根据门诊和住院记录，衡量巴西卫生部报销的疾病直接成本。
2010-2016 年期间，归因于糖尿病的 CKD 和 ESKD 成本为 12 亿美元（每年 1.8 亿美元），呈上升趋势。女性、65-75 岁和黑种人/黑肤色人群对 CKD 和 ESKD 的成本贡献较大（分别为 4.75 亿美元、6300 万美元和 2500 万美元）。导致疾病相关成本的最大临床操作是血液透析和腹膜透析。
糖尿病导致了 22%的 CKD 和 ESKD 相关成本。女性、65-75 岁和黑种人/黑肤色是导致疾病相关支出的主要变量。在未来几年内，CKD 的经济负担可能会逐渐增加，这对巴西公共卫生系统的财务可持续性将产生严重影响。
