Joaquín E Caporale, Jorge F Elgart and Juan J Gagliardino
Introduction: Structured diabetes care programs in Argentina are scarce and do not inform about their cost using micro costing techniques.
Aim: To estimate the incremental costs of a health care program for type 2 diabetes without complications implemented at sub-national level in Argentina during 2005.
Methods: United Kingdom Prospective Diabetes Study and Latin American Diabetes Association guidelines were used to identify which resources should be part of a diabetes program to implement in two Argentinean provinces – Córdoba and Misiones – with high and low socioeconomic characteristics, respectively. A micro costing approach was used to estimate costs from the perspective of a public health payer, taking a province without diabetes program as a comparative scenario. Probabilistic sensitivity analysis following Monte Carlo simulation was used to determine the number of visits and practices, probability of insulin treatment, combination therapy for hypertension, annual number of test strips and unit cost of all resources used.
Results: The main component of the annual incremental cost per patient in both provinces was self-monitoring blood glucose (~50%), followed by treatment of diabetes, dyslipidemia and hypertension. The lowest cost corresponded to human resources (<5%). The annual incremental cost per patient was 32% higher in Córdoba due to the pharmacological treatment of diabetes (> 90%).
Discussion: This study provides original evidence for Argentina that could facilitate the development and further evaluation of diabetes programs and resource use optimization in the public health care subsector in other provinces/countries with comparable socioeconomic and health care settings.