Cost of Chronic Kidney Disease Attributable to Diabetes from the Perspective of the Brazilian Unified Health System

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2018 Oct 2

PMID 30273345

Citations 11

Authors

Gabriela Maria Reis Goncalves

Everton Nunes da Silva

Affiliations

Soon will be listed here.

Abstract

Introduction: Diabetes is the most common cause of chronic kidney disease, with a high economic impact on health systems.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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References

Atkins R, Zimmet P . Diabetic kidney disease: act now or pay later? "World Kidney Day" March 11th 2010. Arch Cardiol Mex. 2010; 80(1):44-7. View

Yu M, Katon W, Young B . Associations between sex and incident chronic kidney disease in a prospective diabetic cohort. Nephrology (Carlton). 2015; 20(7):451-8. PMC: 4465880. DOI: 10.1111/nep.12468. View

Morton R, Schlackow I, Mihaylova B, Staplin N, Gray A, Cass A . The impact of social disadvantage in moderate-to-severe chronic kidney disease: an equity-focused systematic review. Nephrol Dial Transplant. 2015; 31(1):46-56. DOI: 10.1093/ndt/gfu394. View

Jha V, Arici M, Collins A, Garcia-Garcia G, Hemmelgarn B, Jafar T . Understanding kidney care needs and implementation strategies in low- and middle-income countries: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference. Kidney Int. 2016; 90(6):1164-1174. DOI: 10.1016/j.kint.2016.09.009. View

Hill N, Fatoba S, Oke J, Hirst J, OCallaghan C, Lasserson D . Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016; 11(7):e0158765. PMC: 4934905. DOI: 10.1371/journal.pone.0158765. View

Collins A, Foley R, Herzog C, Chavers B, Gilbertson D, Ishani A . United States Renal Data System 2008 Annual Data Report. Am J Kidney Dis. 2008; 53(1 Suppl):S1-374. DOI: 10.1053/j.ajkd.2008.10.005. View

Lewis E, Claggett B, Parfrey P, Burdmann E, McMurray J, Solomon S . Race and ethnicity influences on cardiovascular and renal events in patients with diabetes mellitus. Am Heart J. 2015; 170(2):322-9. DOI: 10.1016/j.ahj.2015.05.008. View

Gregg E, Li Y, Wang J, Burrows N, Ali M, Rolka D . Changes in diabetes-related complications in the United States, 1990-2010. N Engl J Med. 2014; 370(16):1514-23. DOI: 10.1056/NEJMoa1310799. View

Hemmelgarn B, Zhang J, Manns B, Tonelli M, Larsen E, Ghali W . Progression of kidney dysfunction in the community-dwelling elderly. Kidney Int. 2006; 69(12):2155-61. DOI: 10.1038/sj.ki.5000270. View

10.

. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2014; 2(8):634-47. PMC: 4572741. DOI: 10.1016/S2213-8587(14)70102-0. View

11.

da Silva Junior G, Bentes A, Daher E, de Matos S . Obesity and kidney disease. J Bras Nefrol. 2017; 39(1):65-69. DOI: 10.5935/0101-2800.20170011. View

12.

Cherchiglia M, Gomes I, Alvares J, Guerra Junior A, de Assis Acurcio F, Andrade E . [Determinants of expenditures on dialysis in the Unified National Health System, Brazil, 2000 to 2004]. Cad Saude Publica. 2011; 26(8):1627-41. DOI: 10.1590/s0102-311x2010000800016. View

13.

Lorenzo V, Boronat M, Saavedra P, Rufino M, Maceira B, Novoa F . Disproportionately high incidence of diabetes-related end-stage renal disease in the Canary Islands. An analysis based on estimated population at risk. Nephrol Dial Transplant. 2010; 25(7):2283-8. DOI: 10.1093/ndt/gfp761. View

14.

Tsai W, Wu H, Peng Y, Ko M, Wu M, Hung K . Risk Factors for Development and Progression of Chronic Kidney Disease: A Systematic Review and Exploratory Meta-Analysis. Medicine (Baltimore). 2016; 95(11):e3013. PMC: 4839895. DOI: 10.1097/MD.0000000000003013. View

15.

Ene-Iordache B, Perico N, Bikbov B, Carminati S, Remuzzi A, Perna A . Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. Lancet Glob Health. 2016; 4(5):e307-19. DOI: 10.1016/S2214-109X(16)00071-1. View

16.

Seuring T, Archangelidi O, Suhrcke M . The Economic Costs of Type 2 Diabetes: A Global Systematic Review. Pharmacoeconomics. 2015; 33(8):811-31. PMC: 4519633. DOI: 10.1007/s40273-015-0268-9. View

17.

De Cosmo S, Viazzi F, Pacilli A, Giorda C, Ceriello A, Gentile S . Predictors of chronic kidney disease in type 2 diabetes: A longitudinal study from the AMD Annals initiative. Medicine (Baltimore). 2016; 95(27):e4007. PMC: 5058807. DOI: 10.1097/MD.0000000000004007. View

18.

van den Beukel T, de Goeij M, Dekker F, Siegert C, Halbesma N . Differences in progression to ESRD between black and white patients receiving predialysis care in a universal health care system. Clin J Am Soc Nephrol. 2013; 8(9):1540-7. PMC: 3805080. DOI: 10.2215/CJN.10761012. View

19.

Muka T, Imo D, Jaspers L, Colpani V, Chaker L, van der Lee S . The global impact of non-communicable diseases on healthcare spending and national income: a systematic review. Eur J Epidemiol. 2015; 30(4):251-77. DOI: 10.1007/s10654-014-9984-2. View

20.

Schmidt M, Duncan B, Azevedo E Silva G, Menezes A, Monteiro C, Barreto S . Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet. 2011; 377(9781):1949-61. DOI: 10.1016/S0140-6736(11)60135-9. View