Cost of chronic kidney disease attributable to diabetes from the perspective of the Brazilian Unified Health System

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.