Skip to main content
Top
Published in: Orphanet Journal of Rare Diseases 1/2023

Open Access 01-12-2023 | Muscular Dystrophy | Research

Estimated costs for Duchenne muscular dystrophy care in Brazil

Authors: Nayê Balzan Schneider, Erica Caetano Roos, Ana Lúcia Portella Staub, Isabela Possebon Bevilacqua, Ana Carolina de Almeida, Tamiê de Camargo Martins, Natalia Bergamelli Ramos, Priscilla Loze, Jonas Alex Morales Saute, Ana Paula Beck da Silva Etges, Carisi Anne Polanczyk

Published in: Orphanet Journal of Rare Diseases | Issue 1/2023

Login to get access

Abstract

Background

The economic burden of rare diseases on health systems is still not widely measured, with the generation of accurate information about the costs with medical care for subjects with rare diseases being crucial when defining health policies. Duchenne Muscular Dystrophy (DMD) is the most common form of muscular dystrophy, with new technologies recently being studied for its management. Information about the costs related to the disease in Latin America is scarce, and the objective of this study is to evaluate the annual hospital, home care and transportation costs per patient with DMD treatment in Brazil.

Results

Data from 27 patients were included, the median annual cost per patient was R$ 17,121 (IQR R$ 6,786; 25,621). Home care expenditures accounted for 92% of the total costs, followed by hospital costs (6%) and transportation costs (2%). Medications and loss of family, and patient’s productivity are among the most representative consumption items. When disease worsening due to loss of the ability to walk was incorporated to the analysis, it was shown that wheelchair users account for an incremental cost of 23% compared with non-wheelchair users.

Conclusions

This is an original study in Latin America to measure DMD costs using the micro-costing technique. Generating accurate information about costs is crucial to provide health managers with information that could help establish more sustainable policies when deciding upon rare diseases in emerging countries.
Appendix
Available only for authorised users
Literature
1.
go back to reference Caskey CT, Nussbaum RL, Cohan LC, Pollack L. Sporadic occurrence of Duchenne muscular dystrophy: evidence for new mutation. Clin Genet. 1980 Nov;18(5):329–41. Caskey CT, Nussbaum RL, Cohan LC, Pollack L. Sporadic occurrence of Duchenne muscular dystrophy: evidence for new mutation. Clin Genet. 1980 Nov;18(5):329–41.
2.
go back to reference Hoffman EP, Brown RHJ, Kunkel LM. Dystrophin: the protein product of the Duchenne muscular dystrophy locus. Cell 1987 Dec;51(6):919–28. Hoffman EP, Brown RHJ, Kunkel LM. Dystrophin: the protein product of the Duchenne muscular dystrophy locus. Cell 1987 Dec;51(6):919–28.
3.
go back to reference Birnkrant DJ, Bushby K, Bann CM, Apkon SD, Blackwell A, Brumbaugh D, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management. Lancet Neurol. 2018 Mar;17(3):251–67. Birnkrant DJ, Bushby K, Bann CM, Apkon SD, Blackwell A, Brumbaugh D, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management. Lancet Neurol. 2018 Mar;17(3):251–67.
4.
go back to reference Crisafulli S, Sultana J, Fontana A, Salvo F, Messina S, Trifirò G. Global epidemiology of Duchenne muscular dystrophy: an updated systematic review and meta-analysis. Orphanet J Rare Dis. 2020 Jun;15(1):141. Crisafulli S, Sultana J, Fontana A, Salvo F, Messina S, Trifirò G. Global epidemiology of Duchenne muscular dystrophy: an updated systematic review and meta-analysis. Orphanet J Rare Dis. 2020 Jun;15(1):141.
5.
go back to reference Teixeira M, de SR, Martins GMA, Rodrigues JMM, Marques ER. Epidemiologia da distrofia muscular de Duchenne no Ceará / Epidemiology of Duchenne muscular dystrophy in Ceará. BJD. 2020;6(9):69591–603.CrossRef Teixeira M, de SR, Martins GMA, Rodrigues JMM, Marques ER. Epidemiologia da distrofia muscular de Duchenne no Ceará / Epidemiology of Duchenne muscular dystrophy in Ceará. BJD. 2020;6(9):69591–603.CrossRef
6.
go back to reference de Almeida PAD, Machado-Costa MC, Manzoli GN, Ferreira LS, Rodrigues MCS, Bueno LSM, et al. Genetic profile of brazilian patients with dystrophinopathies. Clin Genet. 2017 Aug;92(2):199–203. de Almeida PAD, Machado-Costa MC, Manzoli GN, Ferreira LS, Rodrigues MCS, Bueno LSM, et al. Genetic profile of brazilian patients with dystrophinopathies. Clin Genet. 2017 Aug;92(2):199–203.
7.
go back to reference Broomfield J, Hill M, Guglieri M, Crowther M, Abrams K. Life Expectancy in Duchenne muscular dystrophy: reproduced individual Patient Data Meta-analysis. Neurology. 2021 Dec;97(23):e2304–14. Broomfield J, Hill M, Guglieri M, Crowther M, Abrams K. Life Expectancy in Duchenne muscular dystrophy: reproduced individual Patient Data Meta-analysis. Neurology. 2021 Dec;97(23):e2304–14.
8.
go back to reference Bushby K, Finkel R, Birnkrant DJ, Case LE, Clemens PR, Cripe L, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and pharmacological and psychosocial management. Lancet Neurol. 2010 Jan;9(1):77–93. Bushby K, Finkel R, Birnkrant DJ, Case LE, Clemens PR, Cripe L, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and pharmacological and psychosocial management. Lancet Neurol. 2010 Jan;9(1):77–93.
9.
go back to reference Passamano L, Taglia A, Palladino A, Viggiano E, D’Ambrosio P, Scutifero M, et al. Improvement of survival in Duchenne muscular dystrophy: retrospective analysis of 835 patients. Acta Myol. 2012 Oct;31(2):121–5. Passamano L, Taglia A, Palladino A, Viggiano E, D’Ambrosio P, Scutifero M, et al. Improvement of survival in Duchenne muscular dystrophy: retrospective analysis of 835 patients. Acta Myol. 2012 Oct;31(2):121–5.
10.
go back to reference Araujo APQC, de Carvalho AAS, Cavalcanti EBU, Saute JAM, Carvalho E, França MCJ, et al. Brazilian consensus on Duchenne muscular dystrophy. Part 1: diagnosis, steroid therapy and perspectives. Arq Neuropsiquiatr. 2017 Aug;75(8):104–13. Araujo APQC, de Carvalho AAS, Cavalcanti EBU, Saute JAM, Carvalho E, França MCJ, et al. Brazilian consensus on Duchenne muscular dystrophy. Part 1: diagnosis, steroid therapy and perspectives. Arq Neuropsiquiatr. 2017 Aug;75(8):104–13.
11.
go back to reference Werneck LC, Lorenzoni PJ, Ducci RDP, Fustes OH, Kay CSK, Scola RH. Duchenne muscular dystrophy: an historical treatment review. Arq Neuropsiquiatr. 2019 Sep;77(8):579–89. Werneck LC, Lorenzoni PJ, Ducci RDP, Fustes OH, Kay CSK, Scola RH. Duchenne muscular dystrophy: an historical treatment review. Arq Neuropsiquiatr. 2019 Sep;77(8):579–89.
12.
go back to reference Brasil. Ministério da Saúde. Monitoramento do Horizonte Tecnológico: medicamentos para tratamento da distrofia muscular de Duchenne. Brasília: Ministério da Saúde; 2022. p. 45. Brasil. Ministério da Saúde. Monitoramento do Horizonte Tecnológico: medicamentos para tratamento da distrofia muscular de Duchenne. Brasília: Ministério da Saúde; 2022. p. 45.
13.
go back to reference Cannizzo S, Lorenzoni V, Palla I, Pirri S, Trieste L, Triulzi I, et al. Rare diseases under different levels of economic analysis: current activities, challenges and perspectives. RMD Open. 2018;4(Suppl 1):e000794.CrossRefPubMedPubMedCentral Cannizzo S, Lorenzoni V, Palla I, Pirri S, Trieste L, Triulzi I, et al. Rare diseases under different levels of economic analysis: current activities, challenges and perspectives. RMD Open. 2018;4(Suppl 1):e000794.CrossRefPubMedPubMedCentral
14.
go back to reference Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde. Departamento de Gestão e Incorporação de Tecnologias e Inovação em Saúde. Diretriz Metodológica: estudos de microcusteio aplicados a avaliações econômicas em saúde. 2021. 71p. Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde. Departamento de Gestão e Incorporação de Tecnologias e Inovação em Saúde. Diretriz Metodológica: estudos de microcusteio aplicados a avaliações econômicas em saúde. 2021. 71p.
15.
go back to reference Keel G, Savage C, Rafiq M, Mazzocato P. Time-driven activity-based costing in health care: a systematic review of the literature. Health Policy. 2017 Jul;121(7):755–63. Keel G, Savage C, Rafiq M, Mazzocato P. Time-driven activity-based costing in health care: a systematic review of the literature. Health Policy. 2017 Jul;121(7):755–63.
17.
go back to reference Schreiber-Katz O, Klug C, Thiele S, Schorling E, Zowe J, Reilich P, et al. Comparative cost of illness analysis and assessment of health care burden of Duchenne and Becker muscular dystrophies in Germany. Orphanet J Rare Dis. 2014 Dec;9:210. Schreiber-Katz O, Klug C, Thiele S, Schorling E, Zowe J, Reilich P, et al. Comparative cost of illness analysis and assessment of health care burden of Duchenne and Becker muscular dystrophies in Germany. Orphanet J Rare Dis. 2014 Dec;9:210.
18.
go back to reference Araujo APQC, Nardes F, Fortes CPDD, Pereira JA, Rebel MF, Dias CM, et al. Brazilian consensus on Duchenne muscular dystrophy. Part 2: rehabilitation and systemic care. Arq Neuropsiquiatr. 2018 Jul;76(7):481–9. Araujo APQC, Nardes F, Fortes CPDD, Pereira JA, Rebel MF, Dias CM, et al. Brazilian consensus on Duchenne muscular dystrophy. Part 2: rehabilitation and systemic care. Arq Neuropsiquiatr. 2018 Jul;76(7):481–9.
20.
go back to reference Beckers P, Caberg JH, Dideberg V, Dangouloff T, den Dunnen JT, Bours V, et al. Newborn screening of duchenne muscular dystrophy specifically targeting deletions amenable to exon-skipping therapy. Sci Rep. 2021 Feb;11(1):3011. Beckers P, Caberg JH, Dideberg V, Dangouloff T, den Dunnen JT, Bours V, et al. Newborn screening of duchenne muscular dystrophy specifically targeting deletions amenable to exon-skipping therapy. Sci Rep. 2021 Feb;11(1):3011.
21.
go back to reference Aartsma-Rus A, Krieg AM. FDA approves Eteplirsen for Duchenne muscular dystrophy: the next chapter in the Eteplirsen Saga. Nucleic Acid Ther. 2017 Feb;27(1):1–3. Aartsma-Rus A, Krieg AM. FDA approves Eteplirsen for Duchenne muscular dystrophy: the next chapter in the Eteplirsen Saga. Nucleic Acid Ther. 2017 Feb;27(1):1–3.
Metadata
Title
Estimated costs for Duchenne muscular dystrophy care in Brazil
Authors
Nayê Balzan Schneider
Erica Caetano Roos
Ana Lúcia Portella Staub
Isabela Possebon Bevilacqua
Ana Carolina de Almeida
Tamiê de Camargo Martins
Natalia Bergamelli Ramos
Priscilla Loze
Jonas Alex Morales Saute
Ana Paula Beck da Silva Etges
Carisi Anne Polanczyk
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Orphanet Journal of Rare Diseases / Issue 1/2023
Electronic ISSN: 1750-1172
DOI
https://doi.org/10.1186/s13023-023-02767-6

Other articles of this Issue 1/2023

Orphanet Journal of Rare Diseases 1/2023 Go to the issue